Fibroblast Growth Factor 23 Levels Associate with AKI and Death in Critical Illness
Fibroblast Growth Factor 23 Levels Associate with AKI and Death in Critical Illness
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DOI：
10.1681/asn.2016080836
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发表时间：
2017-06-01
影响因子：
13.6
通讯作者：
Waikar, Sushrut S.
中科院分区：
文献类型：
--
作者：
Leaf, David E.;Jacob, Kirolos A.;Waikar, Sushrut S.
骨细胞衍生激素成纤维细胞生长因子23（FGF 23）的血浆水平升高已成为CKD患者心血管疾病和死亡的有力生物标志物。目前尚不清楚尿或血浆FGF 23水平升高是否与重症患者的阿基和死亡有关。因此，我们对一家学术医学中心的350例重症监护室收治的重症患者进行了一项前瞻性队列研究，以调查较高的尿FGF 23水平是否与阿基或住院死亡率（阿基/死亡）的复合终点相关。我们在进入重症监护室的24小时内测量了尿FGF 23水平。在一个子队列（n=131）中，我们还测量了FGF 23、钙、磷酸盐、甲状旁腺激素和维生素D代谢产物的血浆水平。尿液和血浆FGF 23水平与阿基/死亡显著相关，但其他矿物质代谢产物无相关性。在多变量分析中，尿FGF 23水平最高的患者比尿FGF 23水平最低的患者发生阿基/死亡的几率高3.9倍（95%置信区间，1.6 - 9.5）。较高的尿FGF 23水平也与较大的住院时间、90天和1年死亡率、较长的住院时间以及其他一些重要的不良结局独立相关。总之，尿液或血浆中FGF 23水平升高可能是危重患者阿基、死亡和其他不良结局的一种有前景的新生物标志物。
Elevated plasma levels of the osteocyte-derived hormone fibroblast growth factor 23 (FGF23) have emerged as a powerful biomarker of cardiovascular disease and death in patients with CKD. Whether elevated urinary or plasma FGF23 levels are prospectively associated with AKI and death in critically ill patients is unknown. We therefore conducted a prospective cohort study of 350 critically ill patients admitted to intensive care units at an academic medical center to investigate whether higher urinary FGF23 levels associate with the composite end point of AKI or in-hospital mortality (AKI/death). We measured urinary FGF23 levels within 24 hours of admission to the intensive care unit. In a subcohort (n=131) we also measured plasma levels of FGF23, calcium, phosphate, parathyroid hormone, and vitamin D metabolites. Urinary and plasma FGF23 levels, but not other mineral metabolites, significantly associated with AKI/death. In multivariate analyses, patients in the highest compared with the lowest quartile of urinary FGF23 had a 3.9 greater odds (95% confidence interval, 1.6 to 9.5) of AKI/death. Higher urinary FGF23 levels also independently associated with greater hospital, 90-day, and 1-year mortality; longer length of stay; and several other important adverse outcomes. In conclusion, elevated FGF23 levels measured in the urine or plasma may be a promising novel biomarker of AKI, death, and other adverse outcomes in critically ill patients.