Author + information
- Ahmet Bacaksız1,
- Ziya Ismailoglu1,
- Ahu Sarbay2,
- Sitki Kucukbuzcu1,
- Seref Kul1,
- Abdurrahman Tasal1,
- Osman Sonmez1,
- Ercan Erdogan1,
- Murat Turfan1,
- Mehmet Akif Vatankulu1,
- Parviz Jafarov1,
- Mehmet Ergelen1 and
- Omer Goktekin1
Atherosclerosis is a chronic inflammatory process and systemic inflammation plays key role in each step from endothelial dysfunction, formation of atheromatous plaques, to clinical presentation as symptomatic coronary artery disease (CAD) due to plaque rupture and formation of occlusive thrombus. Neutrophil gelatinase-associated lipocalin (NGAL) is a protein secreted by activated neutrophils which recently demonstrated as a diagnostic marker of CAD. The aim of this study is to investigate clinical relevance of circulating NGAL levels in patents who underwent coronary angiography with suspected CAD.
One hundred and five consecutive patients (49 females, 56 males; mean age 59.7 years) who underwent first-time diagnostic coronary angiography from March 2013 to June 2013 were included in this study. Peripheral blood samples were taken from antecubital vein for determination of hemogram and serum NGAL concentrations before coronary angiography. Patients with impaired renal function and elevated white blood cell counts were excluded. The severity and extent of CAD was evaluated by calculation of vessel and Gensini scores. Also, SYNTAX score was calculated in patients with ≥50% stenosis. Results were reported as mean ± standard deviation and percentages. Continuous variables were analyzed using the Student's t-test. A value of p < 0.05 was considered statistically significant.
Demographic and clinical characteristics of the patients were listed in Table 1. Patients with CAD (group 2) were significantly older compared to patients without CAD (group 1) and the number of male patients were significantly higher in group 2 (p<0.05). Although white blood cell and polymorphonuclear neutrophil counts were not different in both groups, neutrophil to lymphocyte ratio (NLR) was significantly elevated in group 2 (p=0.04). Serum NGAL levels in patients with CAD were significantly higher than those in patients without CAD (11.9 ± 3.3 vs 6.0 ± 1.3 pg/mL; p<0.01). The NGAL levels were correlated with NLR, the number of diseased vessels and Gensini score but not with the SYNTAX score (Figure 1). The diagnostic value for serum NGAL in discriminating patients without CAD from those with CAD was high (AUC=0.975). If we used as cutoff for serum NGAL 7.5 pg/mL, we could predict presence of CAD with sensitivity and specifity, 92.3% and 97.5%, respectively.
We demonstrated that serum levels of NGAL as a biomarker of neutrophil activation are higher in patients with CAD than in patients without CAD. It could be used to discriminate patients with CAD before diagnostic coronary angiography. Also, it was positively and significantly correlated with severity and extent of CAD.
|Variable||Group 1(n=26)||Group 2 (n= 79)||p|
|Age (years)||54.0 ± 10.2||61.3 ± 9.4||<0.01|
|Male gender (%)||7 (26.9)||49 (62.0)||<0.01|
|BMI (kg/m2)||29.9 ± 4.0||29.5 ± 5.2||0.73|
|Waist circumference (cm)||99.5 ± 9.5||104.7 ± 9.9||0.11|
|Current smoker (%)||6 (23.1)||21 (26.6)||0.72|
|Hypertension (%)||11 (42.3)||32 (40.5)||0.91|
|Diabetes mellitus (%)||5 (19.2)||20 (25.3)||0.57|
|Dyslipidemia (%)||4 (15.4)||15 (19.0)||0.74|
|WBC (x103/mL)||7.2 ± 1.4||7.5 ± 1.9||0.42|
|Neutrophil count (x103/mL)||3.9 ± 1.0||4.4 ± 1.2||0.11|
|Neutrophil/Lymphocyte Ratio||1.7 ± 0.4||2.0 ± 0.8||0.04|
|Vessel score||0||0.8 ± 1.1 (0–3)||<0.01|
|Gensini score||0||44.2 ± 58.5 (1–204)||<0.01|
|SYNTAX score||0||11.7 ± 6.6 (2–26)||<0.01|
|NGAL (pg/mL)||6.0 ± 1.3||11.9 ± 3.3||<0.01|
Patient demographics and clinical characteristics.