Prognostic utility of plasma neutrophil gelatinase-associated lipocalin in patients with acute heart failure: the NGAL EvaLuation Along with B-type NaTriuretic Peptide in acutely decompensated heart failure (GALLANT) trial

Alan S Maisel, Christian Mueller, Robert Fitzgerald, Robert Brikhan, Brian C Hiestand, Navaid Iqbal, Paul Clopton, Dirk J van Veldhuisen, Alan S Maisel, Christian Mueller, Robert Fitzgerald, Robert Brikhan, Brian C Hiestand, Navaid Iqbal, Paul Clopton, Dirk J van Veldhuisen

Abstract

Aims: Neutrophil gelatinase-associated lipocalin (NGAL) is a measure of acute kidney injury. Renal dysfunction portends significant risk after discharge from acute heart failure (AHF). Thus, a sensitive marker of renal injury might also help to risk stratify HF patients.

Methods and results: GALLANT [NGAL EvaLuation Along with B-type NaTriuretic Peptide (BNP) in acutely Decompensated Heart Failure] was a multicentre, prospective study to assess the utility of plasma NGAL, alone and in combination with BNP, as an early risk marker of adverse outcomes. We studied 186 patients (61% male). There were 29 events (AHF readmissions and all-cause mortality) at 30 days (16%). Patients with events had higher levels of NGAL than those without (134 vs. 84 ng/mL, P < 0.001). The area under the receiver operating characteristic curve was higher for NGAL (0.72) than BNP (0.65), serum creatinine (0.57), or estimated glomerular filtration rate (eGFR; 0.55). In multivariable analyses, NGAL predicted events (P= 0.001), BNP approached significance (P= 0.052 and 0.070 without creatinine and GFR, respectively) while neither serum creatinine nor eGFR were significant. The addition of discharge NGAL over BNP alone improved classification by a net 10.3% in those with events and 19.5% in those without events, for a net reclassification improvement of 29.8% (P= 0.010). Subjects with both BNP and NGAL elevated were at significant risk [hazard ratio (HR) = 16.85, P= 0.006], as were subjects with low BNP and high NGAL (HR = 9.95, P= 0.036).

Conclusions: Plasma NGAL is a measure of kidney injury that at the time of discharge is a strong prognostic indicator of 30 days outcomes in patients admitted for AHF.

Clinical trial registration number: NCT 00693745.

Trial registration: ClinicalTrials.gov NCT00693745.

Figures

Figure 1
Figure 1
Box plots of markers at discharge. Boxes indicate medians and quartiles, whiskers indicate 10th and 90th percentiles.
Figure 2
Figure 2
Receiver operating characteristic curve analysis for markers predicting heart failure re-hospitalization or all-cause mortality.
Figure 3
Figure 3
Kaplan–Meier plots of heart failure re-hospitalization free survival based on cut-offs of 100 ng/mL for neutrophil gelatinase-associated lipocalin and 330 pg/mL for B-type natriuretic peptide. Log rank test P< 0.001.

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