ROLE OF THE SERUM NGAL FOR ASSESSMENT OF HOSPITAL PROGNOSIS IN MEN WITH ST ELEVATION MYOCARDIAL INFARCTION

Aim. To evaluate clinical significance of serum NGAL in ST elevation myocardial infarction (STEMI) patients in relation with the occurrence of in-hospital period complications.

Material and methods. Totally 260 men included with STEMI, hospitalized in 24 hours after the onset of clinical symptoms of the disease. The measurement of serum NGAL concentration (ng/ml, sNGAL) at 1st and 2nd day of hospitalization was done with the hard-phase immune-enzyme analysis by Hycult® biotech assay (USA), registration was done on the plain reader “UNIPLAN” (SPF “PIKON”, Russia). At the stage of in-hospital treatment we registrated endpoints — signs of coronary failure (early post infarction angina, recurrent MI), grade of acute coronary failure (Killip I-IV class), grade of chronic heart failure (by NYHA), hospital mortality.

Results. Patients were selected into 2 groups depending on the endpoints occurrence at hospital stage. Adverse hospital outcome (at least one endpoint) was found in 83 (32%) patients. The level of renal damage sNGAL, measured on the 1st day did not reveal any difference between groups with adverse or benign course of MI in hospital, and on 12th day the sNGAL concentration was significantly higher in group with adverse course — 2,1 ng/ml (1,44; 2,8) vs 1,55 ng/ml (1,11; 2,3), p=0,033. Monofactor analysis showed significance for adverse outcome, the factors as 2nd type diabetes, age >60 y., the fact of glomerular filtration rate decline during hospitalization, increase of sNGAL by 12th day. By the result of multifactor analysis — increase of the age by 1 year increases the chance of adverse outcome by 14%, increase of sNGAL by 12th day of MI increases adverse outcome chance by 3,2 times. the level of sNGAL ≥1,046 ng/ml associated with complicated course of in-hospital MI period.

Conclusion. The level of sNGAL, measured on 1st day of MI did not have prognostic value for the inhospital complications, however concentration of sNGAL on 12th day was associated with already occured adverse outcomes, being a marker of MI severity.

1. Smirnov AV, Kayukov IG Dobronravov VA, et al. Acute kidney injury — a new concept in nephrology. Сlinical nephrology 2009; 1: 11-5. Russian (Смирнов А.В., Каюков И.Г., Добронравов В.А. и др. Острое повреждение почек — новое понятие в нефрологии. Клиническая нефрология 2009; 1: 11-5).

2. Mukhin NA, Svistunov АА, Fomin VV. Сlinical diagnosis progress and continuing medical education. Therapeutic journal archive 2014; 4: 4-8. Russian (Мухин Н.А., Свистунов А.А., Фомин В.В. Прогресс клинической диагностики и непрерывное медицинское образование. Терапевтический архив, 2014; 4: 4-8).

3. Ehrlich AD. Registers of acute coronary syndromes — their types, characteristics and place in clinical practice. Bulletin of Medical Sciences 2012; 4: 30-9. Russian (Эрлих А.Д. Регистры острых коронарных синдромов — их виды, характеристики и место в клинической практике. Вестник РАМН 2012; 4: 30-9).

4. Levey AS, Stevens AL, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009; 150 (9): 604-12.

5. Siew D, Ikizler TA, Gebretsadik T, et al. Elevated Urinary IL-18 Levels at the Time of ICU Admission Predict Adverse Clinical Outcomes. CJASN August 2010; 5, 8: 1497-505.

6. Siew ED, Ware LB, Gebretsadik T, et al. Urine neutrophil gelatinase-associated lipocalin moderately predicts acute kidney injury in critically ill adults. J Am Soc Nephrol 2009; 20: 1823-32.

7. Bolignano D, Lacquaniti A, Coppolino G, et al. Neutrophil Gelatinase-Associated Lipocalin (NGAL) and Progression of Chronic Kidney Disease. CJASN February 2009; 4, 2: 337-44.

8. Zoccali C. The burden of cardiovascular disease in patients with chronic kidney disease and in end-stage renal disease. Contrib Nephrol 2008; 161: 63-7.

9. Daniels LB, Clopton P, Laughlin GA, et al. NGAL is Independently Associated with Cardiovascular Disease and All-Cause Mortality in Community-Dwelling Older Adults: The Rancho Bernardo Study. Circulation. 2011; 124: A11415.

10. Bolignano D, Lacquaniti A, Coppolino G, et al. Neutrophil Gelatinase-Associated Lipocalin (NGAL) and Progression of Chronic Kidney Disease CJASN February 2009; 4, 2: 337-44.

11. Ling W, Zhaohui N, Ben H, et al. Urinary IL-18 and NGAL as early predictive biomarkers in contrast-induced nephropathy after coronary angiography. Nephron Clin Pract 2008; 108: 176-81.

12. Maisel AS, Fitzgerald R, Mueller C, et al. Prognostic Utility of Plasma NGAL in Patients Admitted With Heart Failure-30 Day Results of the GALLANT Trial. Circulation. 2010; 122: A12359.

13. Soto K, Papoila AL, Coelho S, et al. Plasma NGAL for the Diagnosis of AKI in Patients Admitted from the Emergency Department Setting. CJASN December 06, 2013; 8, 12: 2053-63.

14. Bolignano D, Lacquaniti A, Coppolino G, et al. Neutrophil gelatinase-associated lipocalin reflects the severity of renal impairment in subjects affected by chronic kidney disease. Kidney Blood Press Res 2008; 31: 255-8.

15. Mori K, Nakao K. Neutrophil gelatinase-associated lipocalin as the real-time indicator of active kidney damage. Kidney Int 2007; 71: 967-70.