Neutrophil Gelatinase-Associated Lipocalin for the Assessment of Persistent Renal Dysfunction after Acute Kidney...

Renal injury is a significant complication in ST-segment elevation myocardial infarction (STEMI) and is associated with poor outcomes. The recently introduced term acute kidney disease (AKD) describes persistent renal dysfunction lasting 7-90 days post-acute kidney injury (AKI). Neutrophil gelatinase-associated lipocalin (NGAL), a biomarker for tubular injury, has shown promise in predicting AKI. This study aimed to evaluate NGAL's diagnostic utility for predicting AKD in STEMI patients.

This prospective observational study included 312 patients admitted with STEMI. NGAL levels were measured within 2 h of admission. AKI and AKD were defined using KDIGO criteria, and patients with chronic inflammation or end-stage renal disease were excluded. Receiver operating characteristic (ROC) analysis was performed to evaluate NGAL's predictive value for AKD and its optimal value for prediction.

Overall, 64 patients developed AKI (21%), with 30 (47%) progressing to AKD. Patients with AKD had higher admission NGAL levels (median 165 ng/mL) compared to those with resolved AKI (112 ng/mL) or no AKI (88 ng/mL, p < 0.001). NGAL had a good predictive ability for AKD (area under the ROC of 0.784), with a threshold of >150 ng/mL having 65% sensitivity and 77% specificity for correct prediction. Multivariate analysis confirmed NGAL >150 ng/mL as an independent predictor of AKD (HR 6.4, 95% CI 1.94-21.06, p < 0.001)).

Elevated NGAL levels are independently associated with AKD development in STEMI patients. These findings suggest NGAL could be a valuable biomarker for early risk stratification, supporting timely interventions to mitigate persistent renal injury. Further research is warranted to confirm its clinical utility.