Abstract
Background: In order to predict the occurrence of worsening renal function (WRF) and of WRF plus in-hospital death, 101 emergency department (ED) patients with acute decompensated heart failure (ADHF) were evaluated with testing for amino-terminal pro-B-type natriuretic peptide (NT-proBNP), BNP, sST2, and neutrophil gelatinase associated lipocalin (NGAL).
Methods: In a prospective international study, biomarkers were collected at the time of admission; the occurrence of subsequent in hospital WRF was evaluated.
Results: In total 26% of patients developed WRF. Compared to patients without WRF, those with WRF had a longer in-hospital length of stay (LOS) (mean LOS 13.1±13.4 days vs. 4.8±3.7 days, p<0.001) and higher in-hospital mortality [6/26 (23%) vs. 2/75 (2.6%), p<0.001]. Among the biomarkers assessed, baseline NT-proBNP (4846 vs. 3024 pg/mL; p=0.04), BNP (609 vs. 435 pg/mL; p=0.05) and NGAL (234 vs. 174 pg/mL; p=0.05) were each higher in those who developed WRF. In logistic regression, the combination of elevated natriuretic peptide and NGAL were additively predictive for WRF (ORNT-proBNP+NGAL=2.79; ORBNP+NGAL=3.11; both p<0.04). Rates of WRF were considerably higher in patients with elevation of both classes of biomarker. Comparable results were observed in a separate cohort of 162 patients with ADHF from a different center.
Conclusions: In ED patients with ADHF, the combination of NT-proBNP or BNP plus NGAL at presentation may be useful to predict impending WRF (Clinicaltrials.gov NCT#0150153).
Acknowledgments
The authors wish to thank the emergency departments from our respective institutions for their support.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Financial support: Dr. Nagurney has received grant support from Alere, Nanosphere, and Thermo Fisher. Dr. Di Somma has received grant support from Alere. Dr. Januzzi has received grant support from Roche Diagnostics, Critical Diagnostics, BG Medicine, Thermo Fisher, and Siemens. The other authors have no conflicts to report.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. Peacock WF, Mueller C, Disomma S, Maisel A. Emergency department perspectives on B-type natriuretic peptide utility. Congest Heart Fail 2008;14:17–20.10.1111/j.1751-7133.2008.tb00005.xSearch in Google Scholar PubMed
2. Yancy CW, Lopatin M, Stevenson LW, De Marco T, Fonarow GC; ADHERE Scientific Advisory Committee and Investigators. Clinical presentation, management, and in-hospital outcomes of patients admitted with acute decompensated heart failure with preserved systolic function: a report from the Acute Decompensated Heart Failure National Registry (ADHERE) Database. J Am Coll Cardiol 2006;47:76–84.10.1016/j.jacc.2005.09.022Search in Google Scholar PubMed
3. Cowie MR, Komajda M, Murray-Thomas T, Underwood J, Ticho B, POSH Investigators. Prevalence and impact of worsening renal function in patients hospitalized with decompensated heart failure: results of the prospective outcomes study in heart failure (POSH). Eur Heart J 2006;27:1216–22.10.1093/eurheartj/ehi859Search in Google Scholar PubMed
4. Verdiani V, Lastrucci V, Nozzoli C. Worsening renal function in patients hospitalized with acute heart failure: risk factors and prognostic significances. Int J Nephrol 2011;2011:785974.10.4061/2011/785974Search in Google Scholar PubMed PubMed Central
5. Damman K, Jaarsma T, Voors AA, Navis G, Hillege HL, van Veldhuisen DJ, COACH investigators. Both in- and out-hospital worsening of renal function predict outcome in patients with heart failure: results from the Coordinating Study Evaluating Outcome of Advising and Counseling in Heart Failure (COACH). Eur J Heart Fail 2009;11:847–54.10.1093/eurjhf/hfp108Search in Google Scholar PubMed
6. Ronco C, McCullough PA, Anker SD, Anand I, Aspromonte N, Bagshaw SM, et al; Acute Dialysis Quality Initiative (ADQI) consensus group. Cardiorenal syndromes: an executive summary from the consensus conference of the Acute Dialysis Quality Initiative (ADQI). Contrib Nephrol 2010;165:54–67.10.1159/000313745Search in Google Scholar PubMed
7. Gottlieb SS, Abraham W, Butler J, Forman DE, Loh E, Massie BM, et al. The prognostic importance of different definitions of worsening renal function in congestive heart failure. J Card Fail 2002;8:136–41.10.1054/jcaf.2002.125289Search in Google Scholar PubMed
8. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevs.ky P. Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004;8:R204–12.Search in Google Scholar
9. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999;130:461–70.10.7326/0003-4819-130-6-199903160-00002Search in Google Scholar PubMed
10. Tang WH, Mullens W. Cardiorenal syndrome in decompensated heart failure. Heart 2010;96:255–60.10.1136/hrt.2009.166256Search in Google Scholar PubMed
11. Murray PT, Mehta RL, Shaw A, Ronco C, Endre Z, Kellum JA, et al. Current use of biomarkers in acute kidney injury: report and summary of recommendations from the 10th Acute Dialysis Quality Initiative consensus conference. Kidney Int Epub 2013 Oct 9. doi:10.1038/ki.2013.374.10.1038/ki.2013.374Search in Google Scholar PubMed PubMed Central
12. Di Somma S, Magrini L, De Berardinis B, Marino R, Ferri E, Moscatelli P, et al. Additive value of blood neutrophil gelatinase-associated lipocalin to clinical judgement in acute kidney injury diagnosis and mortality prediction in patients hospitalized from the emergency department. Crit Care 2013;17:R29.10.1186/cc12510Search in Google Scholar PubMed PubMed Central
13. Aghel A, Shrestha K, Mullens W, Borowski A, Tang WH. Serum neutrophil gelatinase-associated lipocalin (NGAL) in predicting worsening renal function in acute decompensated heart failure. J Card Fail 2010;16:49–54.10.1016/j.cardfail.2009.07.003Search in Google Scholar PubMed PubMed Central
14. Maisel A, Mueller C, Adams K Jr, Anker SD, Aspromonte N, Cleland JG, et al. State of the art: using natriuretic peptide levels in clinical practice. Eur J Heart Fail 2008;10:824–39.10.1016/j.ejheart.2008.07.014Search in Google Scholar PubMed
15. Bayes-Genis A, de Antonio M, Galán A, Sanz H, Urrutia A, Cabanes R, et al. Combined use of high-sensitivity ST2 and NTproBNP to improve the prediction of death in heart failure. Eur J Heart Fail 2012;14:32–8.10.1093/eurjhf/hfr156Search in Google Scholar PubMed
16. Pascual-Figal DA, Manzano-Fernández S, Boronat M, Casas T, Garrido IP, Bonaque JC, et al. Soluble ST2, high-sensitivity troponin T- and N-terminal pro-B-type natriuretic peptide: complementary role for risk stratification in acutely decompensated heart failure. Eur J Heart Fail 2011;13:718–25.10.1093/eurjhf/hfr047Search in Google Scholar PubMed
17. Rehman SU, Mueller T, Januzzi JL Jr. Characteristics of the novel interleukin family biomarker ST2 in patients with acute heart failure. J Am Coll Cardiol 2008;52:1458–65.10.1016/j.jacc.2008.07.042Search in Google Scholar PubMed
18. Di Somma S, Navarin S, Giordano S, Spadini F, Lippi G, Cervellin G, et al. The emerging role of biomarkers and bio-impedance in evaluating hydration status in patients with acute heart failure. Clin Chem Lab Med 2012;50:2093–105. Review.10.1515/cclm-2012-0289Search in Google Scholar PubMed
19. van Kimmenade RR, Januzzi JL Jr, Baggish AL, Lainchbury JG, Bayes-Genis A, Richards AM, et al. Amino-terminal pro-brain natriuretic peptide, renal function, and outcomes in acute heart failure: redefining the cardiorenal interaction? J Am Coll Cardiol 2006;48:1621–7.10.1016/j.jacc.2006.06.056Search in Google Scholar PubMed
20. McCullough PA, Kellum JA, Haase M, Müller C, Damman K, Murray PT, et al. Pathophysiology of the cardiorenal syndromes: executive summary from the eleventh consensus conference of the Acute Dialysis Quality Initiative (ADQI). Contrib Nephrol 2013;182:82–98.10.1159/000349966Search in Google Scholar PubMed
21. Haase M, Müller C, Damman K, Murray PT, Kellum JA, Ronco C, et al. Pathogenesis of cardiorenal syndrome type 1 in acute decompensated heart failure: workgroup statements from the eleventh consensus conference of the Acute Dialysis Quality Initiative (ADQI). Contrib Nephrol 2013;182:99–116.10.1159/000349969Search in Google Scholar PubMed
22. Tomlanovich S, Golbetz H, Perlroth M, Stinson E, Myers BD. Limitations of creatinine in quantifying the severity of cyclosporine-induced chronic nephropathy. Am J Kidney Dis 1986;8:332–7.10.1016/S0272-6386(86)80107-XSearch in Google Scholar
23. Perrone RD, Madias NE, Levey AS. Serum creatinine as an index of renal function: new insights into old concepts. Clin Chem 1992;38:1933–53. Review.10.1093/clinchem/38.10.1933Search in Google Scholar
24. Waikar SS, Bonventre JV. Creatinine kinetics and the definition of acute kidney injury. J Am Soc Nephrol 2009;20:672–9.10.1681/ASN.2008070669Search in Google Scholar PubMed PubMed Central
25. Desai AS, Toto R, Jarolim P, Uno H, Eckardt KU, Kewalramani R, et al. Association between cardiac biomarkers and the development of ESRD in patients with type 2 diabetes mellitus, anemia, and CKD. Am J Kidney Dis 2011;58:717–28.10.1053/j.ajkd.2011.05.020Search in Google Scholar PubMed
26. van Kimmenade RR, Pinto Y, Januzzi JL, Jr. When renal and cardiac insufficiencies intersect: is there a role for natriuretic peptide testing in the ‘cardio-renal syndrome’? Eur Heart J 2007;28:2960–1.10.1093/eurheartj/ehl399Search in Google Scholar PubMed
27. Macdonald S, Arendts G, Nagree Y, Xu XF. Neutrophil gelatinase-associated lipocalin (NGAL) predicts renal injury in acute decompensated cardiac failure: a prospective observational study. BMC Cardiovasc Disord 2012;12:8.10.1186/1471-2261-12-8Search in Google Scholar PubMed PubMed Central
28. Bhavsar NA, Kottgen A, Coresh J, Astor BC. Neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule 1 (KIM-1) as predictors of incident CKD stage 3: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Kidney Dis 2012;60:233–40.10.1053/j.ajkd.2012.02.336Search in Google Scholar PubMed PubMed Central
29. Breidthardt T, Socrates T, Drexler B, Noveanu M, Heinisch C, et al. Plasma neutrophil gelatinase-associated lipocalin for the prediction of acute kidney injury in acute heart failure. Crit Care 2012;16:R2.10.1186/cc10600Search in Google Scholar PubMed PubMed Central
Supplemental Material
The online version of this article (DOI: 10.1515/cclm-2014-0191) offers supplementary material, available to authorized users.
©2015 by De Gruyter
