Introduction: The accurate prediction of acute kidney injury (AKI) in patients with acute heart failure (AHF) is an\r\nunmet clinical need. Neutrophil gelatinase-associated lipocalin (NGAL) is a novel sensitive and specific marker of\r\nAKI.\r\nMethods: A total of 207 consecutive patients presenting to the emergency department with AHF were enrolled.\r\nPlasma NGAL was measured in a blinded fashion at presentation and serially thereafter. The potential of plasma\r\nNGAL levels to predict AKI was assessed as the primary endpoint. We defined AKI according to the AKI Network\r\nclassification.\r\nResults: Overall 60 patients (29%) experienced AKI. These patients were more likely to suffer from pre-existing\r\nchronic cardiac or kidney disease. At presentation, creatinine (median 140 (interquartile range (IQR), 91 to 203)\r\numol/L versus 97 (76 to 132) umol/L, P < 0.01) and NGAL (114.5 (IQR, 67.1 to 201.5) ng/ml versus 74.5 (60 to 113.9)\r\nng/ml, P < 0.01) levels were significantly higher in AKI compared to non-AKI patients. The prognostic accuracy for\r\nmeasurements obtained at presentation, as quantified by the area under the receiver operating characteristic curve\r\nwas mediocre and comparable for the two markers (creatinine 0.69; 95%CI 0.59 to 0.79 versus NGAL 0.67; 95%CI\r\n0.57 to 0.77). Serial measurements of NGAL did not further increase the prognostic accuracy for AKI. Creatinine, but\r\nnot NGAL, remained an independent predictor of AKI (hazard ratio (HR) 1.12; 95%CI 1.00 to 1.25; P = 0.04) in\r\nmultivariable regression analysis.\r\nConclusions: Plasma NGAL levels do not adequately predict AKI in patients with AHF.
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