New Study Demonstrates how to Identify Heart Failure Patients at Risk of Readmission or Death

According to a new study published in the European Journal of Heart Failure, a point-of-care blood test measuring Neutrophil Gelatinase-Associated Lipocalin (NGAL) in patients admitted to the hospital with acutely decompensated heart failure (HF) may help identify which patients are at risk of experiencing adverse, heart failure related events after discharge. The multi-center, prospective study included five medical centers in the United States and Europe. Blood specimens collected at hospital discharge were measured for NGAL using the Alere Triage® NGAL Test.

Heart failure is often associated with dysfunction of both the heart and kidneys. While previous studies have demonstrated plasma NGAL’s utility in predicting and identifying acute kidney injury (AKI), as well as assessing its severity, the extent to which plasma NGAL levels can provide information that helps identify heart failure patients at risk for hospital readmission or death has been unknown up to this point. If plasma NGAL could aid in the recognition of underlying kidney injury in heart failure patients at discharge, this might allow for management decisions aimed at preserving renal function and preventing readmissions.

This study, led by Dr. Alan Maisel of the San Diego Veterans Affairs Medical Center and Dr. Dirk J. van Velhuisen of the University Medical Center Groningen in the Netherlands, attempted to determine if a simple, point-of-care blood test performed at the time of discharge could aid clinicians in identifying heart failure patients at high risk for readmission. If so, these patients could then be targeted for more intensive follow-up treatment in the clinic—a protocol that might reduce their likelihood for readmission and the associated healthcare costs.

The Alere Triage® NGAL Test is a point-of-care immunoassay used with the Alere Triage® MeterPro for the rapid quantitative determination of NGAL in EDTA anticoagulated whole blood or plasma specimens, and provides results in about 15 minutes.

Plasma NGAL was measured in 194 patients at the time of discharge using the Alere® Triage NGAL Test. BNP, a widely recognized marker for adverse heart failure related outcomes, was also measured along with other markers of kidney function. Patients were then followed for 30 days in order to record heart failure related readmissions and deaths.

The results of this study showed that plasma NGAL was the only renal marker to significantly predict 30-day heart failure related outcomes. Furthermore, plasma NGAL was found to be substantially superior to such conventional measures of renal function as serum creatinine and eGFR. Dr. Maisel, the study’s co-principal investigator, remarked, “We were quite impressed with how powerful a predictor plasma NGAL was at the time of discharge. This may in part be due to the fact that some patients have renal injury at discharge that has not yet manifested itself by elevated creatinine levels.”

Elevation in both NGAL and BNP portended the highest risk of poor outcomes. Dr. Dirk J. van Velhuisen, co-principal investigator of the study explained, “Bringing down BNP levels in patients with acute HF is important, but, by doing so, a significant proportion of patients are at risk to develop renal dysfunction, and NGAL allows early detection and possibly prevention of such problems.”

When used at the point of care, the Alere Triage® NGAL test has been shown to provide critical data that may help clinicians detect AKI early, assess disease severity, predict recovered renal function, and, with this new study, identify HF patients at risk for readmission or death at the time of discharge.