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Fibroblast growth factor 23 (FGF-23) is an early predictor of mortality in patients with cardiac arrest

  • Author Footnotes
    1 These authors have contributed equally to this paper.
    Sebastian Spaich
    Footnotes
    1 These authors have contributed equally to this paper.
    Affiliations
    Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany

    German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany
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  • Author Footnotes
    1 These authors have contributed equally to this paper.
    Thomas Zelniker
    Footnotes
    1 These authors have contributed equally to this paper.
    Affiliations
    Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany

    German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany
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  • Philipp Endres
    Affiliations
    Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany

    German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany
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  • Jan Stiepak
    Affiliations
    Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany

    German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany
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  • Lorenz Uhlmann
    Affiliations
    Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
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  • Raffi Bekeredjian
    Affiliations
    Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany

    German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany
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  • Emmanuel Chorianopoulos
    Affiliations
    Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany

    German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany
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  • Evangelos Giannitsis
    Affiliations
    Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany

    German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany
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  • Johannes Backs
    Affiliations
    Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany

    German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany
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  • Hugo A. Katus
    Affiliations
    Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany

    German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany
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  • Michael R. Preusch
    Correspondence
    Corresponding author at: Department of Cardiology, Angiology and Pneumology University of Heidelberg Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany.
    Affiliations
    Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany

    German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany
    Search for articles by this author
  • Author Footnotes
    1 These authors have contributed equally to this paper.

      Abstract

      Background

      Post-cardiac arrest management has seen significant advances with profound improvements in survival and neurologic outcome. However, early prognostication after return of spontaneous circulation remains most challenging. Biomarkers have evolved as helpful tools in identifying patients who are at increased risk of adverse outcome. While fibroblast growth factor 23 (FGF-23) has recently emerged as a promising predictor of mortality in patients with cardiogenic shock, its role in risk stratification in post-resuscitation management remains unresolved.

      Methods

      This study included 90 patients who had been resuscitated and transferred to the ICU of the University Hospital Heidelberg. Survivors and non-survivors were retrospectively analyzed for known prognostic biomarkers as well as FGF-23 serum levels 24 h and 72 h post cardiac arrest (CA).

      Results

      FGF-23 levels were significantly elevated in non-survivors compared to survivors. ROC analysis of FGF-23 levels at 24 h and 72 h post CA yielded an AUC of 0.759 and 0.726, respectively, for prediction of overall survival after 6 months. FGF-23 levels remained as significant prognosticators after adjusting for age, renal function, and initial cardiac rhythm. FGF-23 levels did not show significant differences in patient outcome after stratification for cardiac origin of CA or left ventricular dysfunction. Furthermore, FGF-23 levels were moderately predictive of poor neurologic outcome in ROC analysis on day 1 and day 3 post CA with an AUC of 0.738 and 0.687, respectively.

      Conclusion

      This study demonstrates elevated FGF-23 serum levels to be potentially helpful in prediction of mortality and poor neurological outcome as early as 24 h post cardiac arrest.

      Abbreviations:

      ACLS (Advanced Cardiac Life Support), AUC (Area under the curve), BLS (Basic Life Support), CA (Cardiac arrest), CI (Confidence Interval), CPC (Cerebral performance category), CPR (Cardiopulmonary Resuscitation), CRP (C-reactive protein), FGF-23 (Fibroblast growth factor 23), GFR (Glomerular filtration rate), HRR (Heidelberg Resuscitation Registry), hsTNT (High-sensitive troponin T), NSE (Neuron specific enolase), NT-proBNP (Brain natriuretic peptide), PEA (pulseless electrical activity), PCT (Procalcitonin), RAAS (Renin-Aldosterone-Angiotensin-System), ROC (Receiver operating curve), ROSC (Return of spontaneous circulation), TTM (targeted temperature management), VF (ventricular fibrillation), VT (ventricular tachycardia)

      Keywords

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