Accepted Manuscript Comparison of Neuthrophil Gelatinase Associated Lipocalin (NGAL) versus B-type Natriuretic Peptide and Cystatin C to Predict early Acute Kidney Injury and Outcome in Patients with Acute Heart Failure Alberto Palazzuoli, MD PhD, Gaetano Ruocco, MD, Marco Pellegrini, MD, Carmelo De Gori, MD, Gabriele Del Castillo, MD, Beatrice Franci, PhD, Ranuccio Nuti, MD, Claudio Ronco, MD PII:

S0002-9149(15)01049-8

DOI:

10.1016/j.amjcard.2015.03.043

Reference:

AJC 21084

To appear in:

The American Journal of Cardiology

Received Date: 17 December 2014 Revised Date:

17 March 2015

Accepted Date: 19 March 2015

Please cite this article as: Palazzuoli A, Ruocco G, Pellegrini M, De Gori C, Del Castillo G, Franci B, Nuti R, Ronco C, Comparison of Neuthrophil Gelatinase Associated Lipocalin (NGAL) versus B-type Natriuretic Peptide and Cystatin C to Predict early Acute Kidney Injury and Outcome in Patients with Acute Heart Failure, The American Journal of Cardiology (2015), doi: 10.1016/j.amjcard.2015.03.043. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

ACCEPTED MANUSCRIPT

Comparison of Neuthrophil Gelatinase Associated Lipocalin (NGAL) versus B-type Natriuretic Peptide and Cystatin C to Predict early Acute Kidney Injury and Outcome in Patients with Acute Heart Failure

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Alberto Palazzuoli MD PhD1 Gaetano Ruocco MD1 Marco Pellegrini MD1 Carmelo De Gori MD1 Gabriele Del Castillo MD1 Beatrice Franci PhD1 Ranuccio Nuti MD1 Claudio Ronco MD2 1

Cardiovascular Diseases Unit, Department of Internal Medicine, Le Scotte Hospital University of

Department of Nephrology Dialysis & Transplantation International Renal Research Institute

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Siena Italy

(IRRIV) St. Bortolo Hospital, Vicenza, Italy

Running Title: NGAL and AKI in acute HF

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Address for correspondence:

Alberto Palazzuoli MD, PhD

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Cardiovascular Diseases Unit, Department of Internal Medicine Le Scotte Hospital, University of Siena, Viale Bracci n. 16, 53100, Siena, Italy

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Fax: +39577233480

Phone: +39577585363-+39577585461 Email:[email protected]

Clinical Trial Registration- Diuretic1 NCT01441245

1

ACCEPTED MANUSCRIPT

SUMMARY Neutrophil Gelatinase-associated Lipocaline (NGAL) has been described in chronic heart failure (HF) as marker of tubular damage and renal dysfunction, however less data are available in acute HF patients. Because of high rate of

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acute kidney injury (AKI) development, we aimed to investigate the role of NGAL, in predicting early AKI development; secondly we compared NGAL respect to Cystatin C, B-type Natriuretic Peptide (BNP), renal function and blood urea nitrogen (BUN) for outcome prediction. We measured admission serum NGAL, Cystatin C, and BNP, in 231 patients affected to acute HF; all patients were submitted to daily creatinine, estimated glomerular filtration rate (eGFR), measurement to identify in- hospital AKI defined by Risk, Injury, Failure, Loss, End-stage kidney disease and

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Acute Kidney Injury Network criteria . We also measured admission and discharge eGFR, creatinine and BUN to evaluate their prognostic role during a 6-months follow-up period. 78 patients developed AKI during hospitalization in

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this subjects, NGAL levels were significantly increased respect to patients without AKI (295± 228 vs 129±108 ng/ml p