Cardiology Letters 2018, 27(6):289-294

The role of novel biomarkers in acute cardiorenal syndrome

Danková M¹, Mináriková Z², Danko J³, Gergel J⁴, Ponťuch P², Goncalvesová E¹

¹ Kardiologická klinika LFUK a NÚSCH, a. s., Oddelenie zlyhávania a transplantácie srdca, Bratislava

² IV. interná klinika LFUK a UN Bratislava

³ Slovenská technická univerzita, Bratislava

⁴ Medirex, a. s. Bratislava, Slovenská republika

Introduction: Acute kidney injury (AKI) represents the significant problem of increased morbidity and mortality in patients with acute heart failure (AHF). Novel biomarkers such as neutrophil gelatinase associated lipocalin (NGAL), tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin-like factor binding protein 7 (IGFBP-7) represent a group of molecules that appear to be relevant for assessing the occurence of AKI in high-risk patients with AHF.

Objectives: The aim of the study was to assess the levels of novel biomarkers and to identify predictors of AKI in patients with acute heart failure.

Methods: We analysed clinical, echocardiographic and selected biomarkers in 72 consecutive patients admitted due to AHF. The majority of patients were admitted with de novo diagnosed AHF (56.9%). Mean age of the patients was 69 ± 10.3 years, with gender distribution 46/26 (M/W). There was heart failure with preserved ejection fraction/heart failure with reduced ejection fraction/heart failure with mid-range ejection fraction in 33/23/16 patients. The mean value of systolic blood pressure was 140.6 ± 30 mmHg. Renal damage was defined according to KDIGO guidelines based on creatinine levels and daily diuresis. Patients were divided into two groups: AKI- (without renal injury, n=52) and AKI+ (with renal injury, n=20).

Results: The development of AKI was recorded in 27% of patients within 72 hours. Patients with AKI + were older (median age: 75 vs. 64 years, p=0.01), with lower BMI (median: 28 vs.29.5 kg/m2, p=0.04), particularly in HFrEF group (45.8%, p=0.002). Urinary NGAL at admission was significantly higher in the AKI+ compared to AKI - group (152 vs. 19.5 ng/ml, p <.0001). Median of TIMP-2 levels in the AKI+ was 194.1 versus 42.5 ng/ml in the AKI- patients (p<.0001). Median of IGFBP-7 in the AKI+ group was 379 versus 92.4 pg/ml in the AKI- group of patients (p<.0001). Except for BMI, parameters such as age, u-NGAL, uTIMP2, u-IGFBP7, s-hemoglobin and LVEF significantly identified development of AKI.

Conclusions: Biomarker levels such as u-NGAL, u-TIMP2, u-IGFBP7 are detectable in urine prior to serum creatinine elevation. The predictors of AKI in the AHF patients were age, elevated levels of cardiac failure markers, and also renal injury markers together with determination of LVEF and s-hemoglobin at admission.

Keywords: biomarkers; cardiorenal syndrome; acute heart failure

Published: June 1, 2018  Show citation