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Serum neutrophil gelatinase-associated lipocalin concentration reflects severity of coronary artery disease in patients without heart failure and chronic kidney disease

Heart and Vessels volume 31, pages 1595–1602 (2016)Cite this article

Abstract

Serum neutrophil gelatinase-associated lipocalin (NGAL) is recognized as a useful biomarker for acute kidney injury. Recently, elevated NGAL levels were reported in patients with heart failure and cardiac events, but the association between serum NGAL and severity of coronary artery disease (CAD) has not been investigated adequately. This study aimed to evaluate the association between serum NGAL concentration and CAD severity in patients without heart failure and chronic kidney disease. Two-hundred thirteen patients [mean age: 66.2 ± 9.2 (SD)] without heart failure and chronic kidney disease (estimated glomerular filtration rate >60 mL/min/1.73 m2) who underwent coronary angiography were retrospectively analyzed using the SYNTAX score. The mean concentration of serum NGAL was 134.3 ± 111.3 ng/mL. A statistically significant correlation was observed between serum NGAL levels and the SYNTAX score (R = 0.18, P = 0.0091). Multivariable analysis also showed elevated serum NGAL as an independent risk factor for a high SYNTAX score (P < 0.01). Moreover, we evaluated the association of serum NGAL and brain natriuretic peptide (BNP) with the SYNTAX score. Patients with high levels of serum NGAL (>100 ng/mL) and high levels of BNP (>25 pg/mL) had a higher SYNTAX score (low–low vs. high–high: 13.8 ± 13.4 vs. 20.8 ± 18.9, P < 0.05). Serum NGAL levels were positively and significantly associated with CAD severity, and the evaluation of both serum NGAL and BNP was useful for predicting CAD in patients without renal dysfunction and heart failure. Serum NGAL might be a biomarker for CAD severity.

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Acknowledgments

We thank Asuka Ishii for her technical assistance. This study was supported by Grants-in-Aid #17659229 (to Y.H.), Core Research for Evolutional Science and Technology from the Ministry of Education, Culture, Sports, Science, and Technology of Japan.

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    Affiliations

    1. Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

      Mikako Katagiri, Masao Takahashi, Masahiro Myojo, Arihiro Kiyosue, Jiro Ando & Issei Komuro

    2. Department of Critical Care Medicine, The University of Tokyo, Tokyo, Japan

      Kent Doi

    3. Tokyo Teishin Hospital, Tokyo, Japan

      Yasunobu Hirata

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    1. Mikako Katagiri
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    Correspondence to Masao Takahashi.

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    M. Katagiri and M. Takahashi have contributed equally to this work.

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    Supplemental Figure 1

    The flow diagram for this study. ACS: acute coronary syndrome; CAG: coronary angiography; eGFR: estimated glomerular filtration rate; LVEF: left ventricular ejection fraction. (TIFF 178 kb)

    Supplemental Figure 2

    Comparison of ROC analysis in patients with a SYNTAX score >18. The ROC analysis showed superiority of NGAL and BNP for predicting a SYNTAX score >18 compared with hs-CRP. AUC: area under the curve; BNP: brain natriuretic peptide; CI: confidence interval; hs-CRP: high-sensitivity C-reactive protein; NGAL: neutrophil gelatinase-associated lipocalin; ROC: receiver operating characteristics. (TIFF 266 kb)

    Supplemental Figure 3

    Distribution plot according to SYNTAX score and NGAL in patients who were excluded the outliers. The SYNTAX score was positively correlated with NGAL (R=0.18, P=0.02) levels. (TIFF 541 kb)

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    Katagiri, M., Takahashi, M., Doi, K. et al. Serum neutrophil gelatinase-associated lipocalin concentration reflects severity of coronary artery disease in patients without heart failure and chronic kidney disease. Heart Vessels 31, 1595–1602 (2016). https://doi.org/10.1007/s00380-015-0776-8

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    • DOI: https://doi.org/10.1007/s00380-015-0776-8

    Keywords

    • Neutrophil gelatinase-associated lipocalin
    • Coronary artery disease
    • Heart failure
    • Chronic kidney disease