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

• Published in: European journal of heart failure Vol. 13; no. 8; pp. 846 - 851
• Main Authors: Maisel, Alan S., Mueller, Christian, Fitzgerald, Robert, Brikhan, Robert, Hiestand, Brian C., Iqbal, Navaid, Clopton, Paul, van Veldhuisen, Dirk J.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.08.2011; Oxford University Press
• Subjects: Acute Disease; Acute heart failure; Acute Kidney Injury - blood; Acute-Phase Proteins; Aged; Aged, 80 and over; Biomarkers; Biomarkers - blood; BNP; Female; Heart Failure - blood; Heart Failure - diagnosis; Humans; Lipocalin-2; Lipocalins - blood; Male; Middle Aged; Natriuretic Peptide, Brain - blood; Pilot Projects; Predictive Value of Tests; Prognosis; Prospective Studies; Proto-Oncogene Proteins - blood; Renal injury; Risk Assessment; Renal injury; Biomarkers; BNP; Acute heart failure
• ISSN: 1388-9842; 1879-0844; 1879-0844
• DOI: 10.1093/eurjhf/hfr087

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