@article{3122100,
    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)",
    author = "Murray, P.T. and Wettersten, N. and van Veldhuisen, D.J. and Mueller, C. and Filippatos, G. and Nowak, R. and Hogan, C. and Kontos, M.C. and Cannon, C.M. and Müeller, G.A. and Birkhahn, R. and Horiuchi, Y. and Clopton, P. and Taub, P. and Vilke, G.M. and Barnett, O. and McDonald, K. and Mahon, N. and NuÑez, J. and Briguori, C. and Passino, C. and Maisel, A.",
    journal = "Journal of Cardiac Failure",
    year = "2019",
    volume = "25",
    number = "8",
    pages = "654-665",
    publisher = "Churchill Livingstone Inc.",
    issn = "1071-9164, 1532-8414",
    doi = "10.1016/j.cardfail.2019.05.009",
    keywords = "creatinine;  diuretic agent;  neutrophil gelatinase associated lipocalin;  biological marker;  LCN2 protein, human;  neutrophil gelatinase associated lipocalin, acute heart failure;  acute kidney failure;  aged;  Article;  cohort analysis;  creatinine blood level;  creatinine urine level;  diagnostic value;  female;  hospitalization;  human;  kidney function;  major clinical study;  male;  multicenter study;  outcome assessment;  priority journal;  prospective study;  renal replacement therapy;  urine sampling;  acute kidney failure;  clinical trial;  glomerulus filtration rate;  heart failure;  international cooperation;  kidney;  kidney function test;  middle aged;  physiology;  urine;  very elderly, Acute Kidney Injury;  Aged;  Aged, 80 and over;  Biomarkers;  Cohort Studies;  Female;  Glomerular Filtration Rate;  Heart Failure;  Hospitalization;  Humans;  Internationality;  Kidney;  Kidney Function Tests;  Lipocalin-2;  Male;  Middle Aged;  Prospective Studies",
    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) ≤ 0.613) did not have diagnostic utility over the first creatinine (AUC 0.662). There were 235 adverse events in 144 patients. uNGAL did not predict (AUCs ≤ 0.647) adverse clinical events better than creatinine (AUC 0.695). Conclusions: uNGAL was not superior to creatinine for predicting WRF or adverse in-hospital outcomes and cannot be recommended for WRF in AHF. © 2019 Elsevier Inc."
}