Correlation of Serum Neutrophil Gelatinaseassociated Lipocalin with Clinical Severity Score in Patients with Acute Coronary Syndrome: A Cross-sectional Study

Abstract

Introduction: Acute Coronary Syndrome (ACS) is a term that encompasses various clinical presentations such as ST-Segment Elevation Myocardial Infarction (STEMI), Non STEMI (NSTEMI), or unstable angina. Neutrophil Gelatinase-associated Lipocalin (NGAL), also known as lipocalin-2, belongs to the lipocalin category of extracellular proteins. Recent research indicates that NGAL levels are increased in different cardiac situations, regardless of the presence of acute renal injury. Aim: To compare the levels of serum NGAL and Global Registry of Acute Coronary Events (GRACE) scores between cases with ACS and Angio-negative cases, and to study the correlation of serum NGAL with the GRACE score (clinical severity score) in ACS patients. Materials and Methods: A cross-sectional study was conducted with 128 patients at the Department of Biochemistry, MKCG Medical College and Hospital, Berhampur, Odisha, India, presenting to the Cardiac Emergency Department from November 2020 to August 2021. Coronary Angiograms (CAG) were done to confirm the presence of Coronary Artery Disease (CAD), and patients were grouped accordingly as Group-1 with ACS patients and Group-2 with angiogram-negative cases. Apart from the routine work-up, including serum urea and creatinine, serum electrolytes, fasting blood sugar, lipid profile, and management, all patients underwent determination of serum NGAL levels and GRACE score at admission. The data were analysis using student’s t-test and Pearson’s correlation test. Results: Among the 128 participants (64 cases in Group-1 and 64 cases in Group-2), Group-1 comprised 37 cases of STEMI, 26 cases of NSTEMI, and one case of unstable angina. Serum NGAL levels were significantly elevated in patients with CAG-proven ACS (140.89±56.47 ng/mL) without any renal dysfunction, sepsis, or overt infection compared to patients without CAD on CAG (52.01±18.39 ng/mL) (p<0.0001). The serum NGAL level exhibited a positive correlation of 0.359 (p=0.004) with the severity of ACS, as measured by the GRACE score. Conclusion: The present study suggests that serum NGAL in patients with ACS may serve as a potential novel biomarker for risk stratification and predicting the severity of the disease.

Keywords

• coronary angiograms
• enzyme-linked immunosorbent assay
• kidney injury
• unstable angina