Date Published: July 24, 2017
Publisher: Public Library of Science
Author(s): Victoria Karetnikova, Anastasia Osokina, Olga Gruzdeva, Evgenya Uchasova, Michael Zykov, Victoria Kalaeva, Vasiliy Kashtalap, Kristina Shafranskaya, Olga Barbarash, Yoshiaki Taniyama.
We aimed to assess the clinical significance of serum levels of neutrophil gelatinase-associated lipocalin (sNGAL) for predicting in-hospital outcomes in patients with ST-elevated myocardial infarction (STEMI). Patients admitted within 24 hours of developing STEMI clinical symptoms were evaluated for sNGAL on hospitalization days 1 and 12. Recurrent myocardial infarction, early post-infarction angina, acute cerebrovascular accident, and death were assessed as adverse outcomes during hospitalization. The actors associated with adverse outcome were evaluated using univariate and multivariate regression analysis. Among the 260 STEMI patients included, 32% had ≥1 adverse in-hospital outcome, and significantly higher sNGAL on day 12, (but not on day 1) compared to sNGAL in patients with favorable outcome (p = 0.033). Type-2 diabetes mellitus, age > 60 years, reduced glomerular filtration rate during hospitalization, and high sNGAL on day 12 were identified as risk factors for adverse in-hospital outcome, associated with a 14% increase for each 1-year increment in age after 60 years, and a dramatic increase (3.2 times) for high sNGAL on day 12, with sNGAL ≥ 1.046 ng/ml indicating complicated hospitalization course. sNGAL concentration on the 12th day was associated with the existing adverse outcomes, acting as a marker of MI severity.
Assessing the risk of adverse outcomes in patients with ST-elevated myocardial infarction (STEMI) represents a tasks in modern cardiology, and requires to analyze not only anamnestic data and the characteristics of the index coronary event, but also the records of ongoing or progressing organ failures, which may complicate the course of the disease .
The study included 260 patients (mean age at admission, 57 years; age range, 51–64 years) admitted between January 2008 and December 2010. The baseline characteristics of all patients included in the study are provided in Table 1.
The value of sNGAL as a marker of acute kidney injury is well established,  as is its role in the assessment of the severity of kidney injury. Thus, according to some authors, increased levels of this marker can be regarded as one of the indications for hemodialysis . Moreover, the independent association of sNGAL with renal failure and progression of CKD was also noted, which likely underlies the high prognostic value of this marker . The relationship between CKD and cardiovascular diseases is known; specifically, the maximum risk of developing cardiovascular disease, as well as the risk of experiencing an unfavorable course of the ongoing cardiovascular disease have been determined among patients with end-stage renal disease . Furthermore, there is evidence regarding the association between increased sNGAL and total mortality rates in elderly individuals .
Using the one-dimensional and multidimensional models, we also demonstrated the value of sNGAL as a factor reflecting the unfavorable course of myocardial infarction. The identified trends suggest that sNGAL can serve as a marker of infarction severity and unfavorable course in the early period of hospitalization for STEMI, and that an increase in sNGAL should be considered a serious development even in patients with absent or minimal clinical manifestations.