Value of plasma NGAL in the 12-month all-cause mortality prognosis of acute heart failure or acute decompensated heart failure

Background: The presence of acute kidney injury in the setting of acute heart failure (AHF) or acute decompensated heart failure (ADHF) is very popular and was called cardiorenal syndrome 1 (CRS1). CRS1 is associated with significant morbidity and mortality. Neutrophil gelatinase-associated lipocalin (NGAL) is an early predictor of acute kidney injury and poor outcomes in various diseases; though, in AHF or ADHF patients, its significance remains poorly understood. This study was aimed to evaluate the 12 month prognostic value of plasma NGAL in AHF or ADHF patients. Methods: There were 139 patients with AHF or ADHF in the department of cardiovascular resuscitation and Interventional cardiology at Ho Chi Minh City 115 People Hospital from September 2018 to March 2019 and 12 months follow-up. A prospective cohort study was carried out. Results: There were 46 all-cause mortality cases (rate 33.1%) 12 months follow up after discharge. There were 11 cases (rate 7.9%) lost to follow-up; mean age 66.12 +/- 15.77, men accounted for 50.4%. The optimal cut-off of NGAL for 12-month all-cause mortality prognosis was> 383.74 ng/ml, AUC 0.632 (95% CI 0.53-0.74, p = 0.011), sensitivity 58.7 %, specificity 68.29 %, negative predictive value74.7%, positive predictive value 50.9%. Kaplan-Meier analysis revealed that the high plasma NGAL (>= 400 ng/ml) group exhibited a worse prognosis than the low plasma NGAL (< 400 ng/ml) group in 12-month all-cause death (Hazard Ratio 2.56; 95%CI 1.35-4.84, P=0.0039. Independent predictors of 12-month all-cause-mortality were identified using multivariable Cox proportional-hazards regression models with backward-stepwise selection method consisted of two variables: level of NGAL, mechanical ventilation at admission. Conclusions: Plasma NGAL and mechanical ventilation at admissions were independent predictors of 12-month all-cause mortality in patients with AHF or ADHF. The survival probability 12-month follow-up of high level NGAL (>= 400 ng/ml) groups were lower than that of low level NGAL (<400 ng/ml), difference was statistically significant chi 2 = 8.31; p = 0.0047 by Kaplan-Meier curve.