Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany.
Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
Resuscitation. 2016 Jan;98:91-6. doi: 10.1016/j.resuscitation.2015.11.012. Epub 2015 Nov 30.
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.
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 24h and 72 h post cardiac arrest (CA).
FGF-23 levels were significantly elevated in non-survivors compared to survivors. ROC analysis of FGF-23 levels at 24h 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.
This study demonstrates elevated FGF-23 serum levels to be potentially helpful in prediction of mortality and poor neurological outcome as early as 24h post cardiac arrest.
心脏停搏后管理取得了重大进展，患者生存率和神经功能预后均得到显著改善。然而，自主循环恢复后的早期预后仍然是最具挑战性的。生物标志物已成为识别高风险不良预后患者的有用工具。虽然成纤维细胞生长因子 23（FGF-23）最近已成为心源性休克患者死亡率的有前途的预测指标，但它在心脏停搏后复苏管理中的风险分层中的作用仍未解决。
本研究纳入了 90 例在海德堡大学医院 ICU 接受复苏并转来的患者。对幸存者和非幸存者进行了回顾性分析，以确定已知的预后生物标志物以及心脏停搏后 24 小时和 72 小时的 FGF-23 血清水平。
与幸存者相比，非幸存者的 FGF-23 水平显著升高。心脏停搏后 24 小时和 72 小时的 FGF-23 水平的 ROC 分析分别得出预测 6 个月后总体生存率的 AUC 为 0.759 和 0.726。在调整年龄、肾功能和初始心脏节律后，FGF-23 水平仍然是显著的预后预测因子。FGF-23 水平在按心脏停搏原因或左心室功能障碍分层后，在患者预后方面没有显示出显著差异。此外，在心脏停搏后第 1 天和第 3 天的 ROC 分析中，FGF-23 水平对不良神经预后具有中等预测价值，AUC 分别为 0.738 和 0.687。
本研究表明，心脏停搏后 24 小时内 FGF-23 血清水平升高可能有助于预测死亡率和不良神经结局。
