Discharge FGF23 level predicts one year outcome in patients admitted with acute heart failure. (1st August 2021)

• Record Type: Journal Article
• Authors: Vergaro, Giuseppe; Aimo, Alberto; Taurino, Ester; Del Franco, Annamaria; Fabiani, Iacopo; Prontera, Concetta; Masotti, Silvia; Musetti, Veronica; Emdin, Michele; Passino, Claudio
• Is Part Of: International journal of cardiology. Volume 336(2021)
• Page Start: 98
• Page End: 104
• Publication Date: 2021-08-01
• Subjects: FGF23 -- Acute heart failure -- Prognosis -- Kidney; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2021.05.028
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Patients with acute heart failure (AHF) show high levels of fibroblast growth factor-23 (FGF23) on admission. We examined if plasma FGF23 changes during an episode of AHF, and if FGF23 holds prognostic significance in this setting. Methods: Consecutive AHF patients were enrolled. Blood samples were collected on admission and at discharge. Patients were then followed for all-cause death or HF hospitalization. Results: Patients (n = 125; median age 76 years [interquartile interval 71–83], 63% men, left ventricular ejection fraction 35% [25%–56%]) had median admission FGF23 70 ng/L (47–100), N-terminal pro-B-type natriuretic peptide (NT-proBNP) 5844 ng/L (2, 503-10, 468), high-sensitivity troponin T (hs-TnT) 40 ng/L (25–72), and soluble suppression of tumorigenesis-2 (sST2) 26 ng/mL (17–37). While other biomarkers decreased, FGF23 increased by 15% from admission to discharge ( p = 0.033), with a significant correlation with percent changes in estimated glomerular filtration rate (rho = 0.306, p = 0.001). Over a 12-month follow-up, 64 patients (51%) experienced the endpoint. They were more often men, older, with higher systolic pulmonary artery pressure (sPAP), higher NT-proBNP, hs-TnT and discharge FGF23. The best FGF23 cut-off at discharge from receiver operating characteristics analysis was 78 ng/L. Both discharge FGF23 and the 78 ng/L cut-off independently predicted outcome in models including gender, sPAP, age, and 1) admission NT-proBNP, 2) discharge NT-proBNP, 3) admission NT-proBNP and hs-TnT, 4) discharge NT-proBNP and hs-TnT. The 78 ng/L cut-off also refined risk reclassification. Conclusions: During an AHF episode, FGF23 increases from admission to discharge, and patients with higher discharge FGF23 have a higher risk of worse outcome. Highlights: Patients with AHF have high FGF23 on admission. FGF23 increases from admission to discharge Patients with higher discharge FGF23 have a higher risk of worse outcome.