Utility of Urine Neutrophil Gelatinase-Associated Lipocalin for Worsening Renal Function during Hospitalization for Acute Heart Failure: Primary Findings of the Urine N-gal Acute Kidney Injury N-gal Evaluation of Symptomatic Heart Failure Study (AKINESIS)

Patrick T. Murray; Nicholas Wettersten; Dirk J. Van Veldhuisen; Christian Mueller; Gerasimos Filippatos; Richard Nowak; Christopher Hogan; Michael C. Kontos; Chad M. Cannon; Gerhard A. Mueller; Robert Birkhahn; Yu Horiuchi; Paul Clopton; Pam Taub; Gary M. Vilke; Olga Barnett; Kenneth McDonald; Niall Mahon; Julio Nunez; Carlo Briguori; Claudio Passino; Alan Maisel

doi:10.1016/j.cardfail.2019.05.009

Utility of Urine Neutrophil Gelatinase-Associated Lipocalin for Worsening Renal Function during Hospitalization for Acute Heart Failure: Primary Findings of the Urine N-gal Acute Kidney Injury N-gal Evaluation of Symptomatic Heart Failure Study (AKINESIS)

Patrick T. Murray^*, Nicholas Wettersten, Dirk J. Van Veldhuisen, Christian Mueller, Gerasimos Filippatos, Richard Nowak, Christopher Hogan, Michael C. Kontos, Chad M. Cannon, Gerhard A. Mueller, Robert Birkhahn, Yu Horiuchi, Paul Clopton, Pam Taub, Gary M. Vilke, Olga Barnett, Kenneth McDonald, Niall Mahon, Julio Nunez, Carlo BriguoriClaudio Passino, Alan Maisel

^*Corresponding author for this work

Cardiovascular Centre (CVC)

Research output: Contribution to journal › Article › Academic › peer-review

27 Citations (Scopus)

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Abstract

Background: Worsening renal function (WRF) during acute heart failure (AHF) occurs frequently and has been associated with adverse outcomes, though this association has been questioned. WRF is now evaluated by function and injury. We evaluated whether urine neutrophil gelatinase-associated lipocalin (uNGAL) is superior to creatinine for prediction and prognosis of WRF in patients with AHF.

Methods and Results: We performed a multicenter, international, prospective cohort of patients with AHF requiring IV diuretics. The primary outcome was whether uNGAL predicted development of WRF, defined as a sustained increase in creatinine of 0.5 mg/dL or >= 50% above first value or initiation of renal replacement therapy, within the first 5 days. The main secondary outcome was a composite of in-hospital adverse events. We enrolled 927 patients (mean 68.5 years of age, 62% men). The primary outcome occurred in 72 patients (7.8%). The first, peak and the ratio of uNGAL to urine creatinine (area under curves (AUC)

Conclusions: uNGAL was not superior to creatinine for predicting WRF or adverse in-hospital outcomes and cannot be recommended for WRF in AHF.

Original language	English
Pages (from-to)	654-665
Number of pages	12
Journal	Journal of Cardiac Failure
Volume	25
Issue number	8
DOIs	https://doi.org/10.1016/j.cardfail.2019.05.009
Publication status	Published - Aug-2019

Keywords

Acute heart failure
worsening renal function
biomarker
BIOMARKERS
DIAGNOSIS
STRATIFICATION
IMPAIRMENT
MANAGEMENT
PROGNOSIS
MORTALITY
THERAPY
DAMAGE
RISK

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Murray, P. T., Wettersten, N., Van Veldhuisen, D. J., Mueller, C., Filippatos, G., Nowak, R., Hogan, C., Kontos, M. C., Cannon, C. M., Mueller, G. A., Birkhahn, R., Horiuchi, Y., Clopton, P., Taub, P., Vilke, G. M., Barnett, O., McDonald, K., Mahon, N., Nunez, J., ... Maisel, A. (2019). Utility of Urine Neutrophil Gelatinase-Associated Lipocalin for Worsening Renal Function during Hospitalization for Acute Heart Failure: Primary Findings of the Urine N-gal Acute Kidney Injury N-gal Evaluation of Symptomatic Heart Failure Study (AKINESIS). Journal of Cardiac Failure, 25(8), 654-665. https://doi.org/10.1016/j.cardfail.2019.05.009

Murray, Patrick T. ; Wettersten, Nicholas ; Van Veldhuisen, Dirk J. et al. / Utility of Urine Neutrophil Gelatinase-Associated Lipocalin for Worsening Renal Function during Hospitalization for Acute Heart Failure : Primary Findings of the Urine N-gal Acute Kidney Injury N-gal Evaluation of Symptomatic Heart Failure Study (AKINESIS). In: Journal of Cardiac Failure. 2019 ; Vol. 25, No. 8. pp. 654-665.

@article{e815a7006ecf44fe8e8f570453b07472,

title = "Utility of Urine Neutrophil Gelatinase-Associated Lipocalin for Worsening Renal Function during Hospitalization for Acute Heart Failure: Primary Findings of the Urine N-gal Acute Kidney Injury N-gal Evaluation of Symptomatic Heart Failure Study (AKINESIS)",

abstract = "Background: Worsening renal function (WRF) during acute heart failure (AHF) occurs frequently and has been associated with adverse outcomes, though this association has been questioned. WRF is now evaluated by function and injury. We evaluated whether urine neutrophil gelatinase-associated lipocalin (uNGAL) is superior to creatinine for prediction and prognosis of WRF in patients with AHF.Methods and Results: We performed a multicenter, international, prospective cohort of patients with AHF requiring IV diuretics. The primary outcome was whether uNGAL predicted development of WRF, defined as a sustained increase in creatinine of 0.5 mg/dL or >= 50% above first value or initiation of renal replacement therapy, within the first 5 days. The main secondary outcome was a composite of in-hospital adverse events. We enrolled 927 patients (mean 68.5 years of age, 62% men). The primary outcome occurred in 72 patients (7.8%). The first, peak and the ratio of uNGAL to urine creatinine (area under curves (AUC)Conclusions: uNGAL was not superior to creatinine for predicting WRF or adverse in-hospital outcomes and cannot be recommended for WRF in AHF.",

keywords = "Acute heart failure, worsening renal function, biomarker, BIOMARKERS, DIAGNOSIS, STRATIFICATION, IMPAIRMENT, MANAGEMENT, PROGNOSIS, MORTALITY, THERAPY, DAMAGE, RISK",

author = "Murray, {Patrick T.} and Nicholas Wettersten and {Van Veldhuisen}, {Dirk J.} and Christian Mueller and Gerasimos Filippatos and Richard Nowak and Christopher Hogan and Kontos, {Michael C.} and Cannon, {Chad M.} and Mueller, {Gerhard A.} and Robert Birkhahn and Yu Horiuchi and Paul Clopton and Pam Taub and Vilke, {Gary M.} and Olga Barnett and Kenneth McDonald and Niall Mahon and Julio Nunez and Carlo Briguori and Claudio Passino and Alan Maisel",

year = "2019",

month = aug,

doi = "10.1016/j.cardfail.2019.05.009",

language = "English",

volume = "25",

pages = "654--665",

journal = "Journal of Cardiac Failure",

issn = "1071-9164",

publisher = "Churchill Livingstone",

number = "8",

}

Murray, PT, Wettersten, N, Van Veldhuisen, DJ, Mueller, C, Filippatos, G, Nowak, R, Hogan, C, Kontos, MC, Cannon, CM, Mueller, GA, Birkhahn, R, Horiuchi, Y, Clopton, P, Taub, P, Vilke, GM, Barnett, O, McDonald, K, Mahon, N, Nunez, J, Briguori, C, Passino, C & Maisel, A 2019, 'Utility of Urine Neutrophil Gelatinase-Associated Lipocalin for Worsening Renal Function during Hospitalization for Acute Heart Failure: Primary Findings of the Urine N-gal Acute Kidney Injury N-gal Evaluation of Symptomatic Heart Failure Study (AKINESIS)', Journal of Cardiac Failure, vol. 25, no. 8, pp. 654-665. https://doi.org/10.1016/j.cardfail.2019.05.009

Utility of Urine Neutrophil Gelatinase-Associated Lipocalin for Worsening Renal Function during Hospitalization for Acute Heart Failure: Primary Findings of the Urine N-gal Acute Kidney Injury N-gal Evaluation of Symptomatic Heart Failure Study (AKINESIS). / Murray, Patrick T.; Wettersten, Nicholas; Van Veldhuisen, Dirk J. et al.
In: Journal of Cardiac Failure, Vol. 25, No. 8, 08.2019, p. 654-665.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Utility of Urine Neutrophil Gelatinase-Associated Lipocalin for Worsening Renal Function during Hospitalization for Acute Heart Failure

T2 - Primary Findings of the Urine N-gal Acute Kidney Injury N-gal Evaluation of Symptomatic Heart Failure Study (AKINESIS)

AU - Murray, Patrick T.

AU - Wettersten, Nicholas

AU - Van Veldhuisen, Dirk J.

AU - Mueller, Christian

AU - Filippatos, Gerasimos

AU - Nowak, Richard

AU - Hogan, Christopher

AU - Kontos, Michael C.

AU - Cannon, Chad M.

AU - Mueller, Gerhard A.

AU - Birkhahn, Robert

AU - Horiuchi, Yu

AU - Clopton, Paul

AU - Taub, Pam

AU - Vilke, Gary M.

AU - Barnett, Olga

AU - McDonald, Kenneth

AU - Mahon, Niall

AU - Nunez, Julio

AU - Briguori, Carlo

AU - Passino, Claudio

AU - Maisel, Alan

PY - 2019/8

Y1 - 2019/8

N2 - Background: Worsening renal function (WRF) during acute heart failure (AHF) occurs frequently and has been associated with adverse outcomes, though this association has been questioned. WRF is now evaluated by function and injury. We evaluated whether urine neutrophil gelatinase-associated lipocalin (uNGAL) is superior to creatinine for prediction and prognosis of WRF in patients with AHF.Methods and Results: We performed a multicenter, international, prospective cohort of patients with AHF requiring IV diuretics. The primary outcome was whether uNGAL predicted development of WRF, defined as a sustained increase in creatinine of 0.5 mg/dL or >= 50% above first value or initiation of renal replacement therapy, within the first 5 days. The main secondary outcome was a composite of in-hospital adverse events. We enrolled 927 patients (mean 68.5 years of age, 62% men). The primary outcome occurred in 72 patients (7.8%). The first, peak and the ratio of uNGAL to urine creatinine (area under curves (AUC)Conclusions: uNGAL was not superior to creatinine for predicting WRF or adverse in-hospital outcomes and cannot be recommended for WRF in AHF.

AB - Background: Worsening renal function (WRF) during acute heart failure (AHF) occurs frequently and has been associated with adverse outcomes, though this association has been questioned. WRF is now evaluated by function and injury. We evaluated whether urine neutrophil gelatinase-associated lipocalin (uNGAL) is superior to creatinine for prediction and prognosis of WRF in patients with AHF.Methods and Results: We performed a multicenter, international, prospective cohort of patients with AHF requiring IV diuretics. The primary outcome was whether uNGAL predicted development of WRF, defined as a sustained increase in creatinine of 0.5 mg/dL or >= 50% above first value or initiation of renal replacement therapy, within the first 5 days. The main secondary outcome was a composite of in-hospital adverse events. We enrolled 927 patients (mean 68.5 years of age, 62% men). The primary outcome occurred in 72 patients (7.8%). The first, peak and the ratio of uNGAL to urine creatinine (area under curves (AUC)Conclusions: uNGAL was not superior to creatinine for predicting WRF or adverse in-hospital outcomes and cannot be recommended for WRF in AHF.

KW - Acute heart failure

KW - worsening renal function

KW - biomarker

KW - BIOMARKERS

KW - DIAGNOSIS

KW - STRATIFICATION

KW - IMPAIRMENT

KW - MANAGEMENT

KW - PROGNOSIS

KW - MORTALITY

KW - THERAPY

KW - DAMAGE

KW - RISK

U2 - 10.1016/j.cardfail.2019.05.009

DO - 10.1016/j.cardfail.2019.05.009

M3 - Article

SN - 1071-9164

VL - 25

SP - 654

EP - 665

JO - Journal of Cardiac Failure

JF - Journal of Cardiac Failure

IS - 8

ER -

Murray PT, Wettersten N, Van Veldhuisen DJ, Mueller C, Filippatos G, Nowak R et al. Utility of Urine Neutrophil Gelatinase-Associated Lipocalin for Worsening Renal Function during Hospitalization for Acute Heart Failure: Primary Findings of the Urine N-gal Acute Kidney Injury N-gal Evaluation of Symptomatic Heart Failure Study (AKINESIS). Journal of Cardiac Failure. 2019 Aug;25(8):654-665. doi: 10.1016/j.cardfail.2019.05.009