Chang Yu-Hsing, Wu Che-Hsiung, Chou Nai-Kuan, Tseng Li-Jung, Huang I-Ping, Wang Chih-Hsien, Wu Vin-Cent, Chu Tzong-Shinn
Division of Nephrology, National Taiwan University Hospital, Taipei NSARF Group (National Taiwan University Hospital Study Group of ARF), Taipei.
Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City School of Medicine, Tzu Chi University, Hualien NSARF Group (National Taiwan University Hospital Study Group of ARF), Taipei.
Ther Adv Chronic Dis. 2020 Oct 13;11:2040622320964161. doi: 10.1177/2040622320964161. eCollection 2020.
Elevated plasma C-terminal fibroblast growth factor-23 (cFGF-23) levels are associated with higher mortality in patients with chronic kidney disease (CKD) and acute kidney injury (AKI). Our study explored the outcome forecasting accuracy of cFGF-23 in critically ill patients with CKD superimposed with AKI (ACKD).
Urine and plasma biomarkers from 149 CKD patients superimposed with AKI before dialysis were checked in this multicenter prospective observational cohort study. Endpoints were 90-day mortality and 90 days free from dialysis after hospital discharge. Associations with study endpoints were assessed using hierarchical clustering analysis, the generalized additive model, the Cox proportional hazard model, competing risk analysis, and discrimination evaluation.
Over a median follow up of 40 days, 67 (45.0%) patients died before the 90th day after hospital discharge and 39 (26.2%) progressed to kidney failure with replacement therapy (KFRT). Hierarchical clustering analysis demonstrated that cFGF-23 levels had better predictive ability for 90-day mortality than did other biomarkers. Higher serum cFGF-23 levels were independently associated with greater risk for 90-day mortality [hazard ratio (HR): 2.5; 95% confidence interval (CI) 1.5-4.1; < 0.001]. Moreover, adding plasma cFGF-23 to the Demirjian AKI risk score model substantially improved risk prediction for 90-day mortality than the Demirjian model alone (integrated discrimination improvement: 0.06; < 0.05; 95% CI 0.02-0.10). The low plasma cFGF-23 group was predicted having more weaning from dialysis in surviving patients (HR = 0.53, 95% CI, 0.29-0.95, = 0.05).
In patients with ACKD, plasma cFGF-23 levels are an independent risk factor to forecast 90-day mortality and 90-day progression to KFRT. In combination with the clinical risk score, plasma cFGF-23 levels could substantially improve mortality risk prediction.
血浆C端成纤维细胞生长因子23（cFGF-23）水平升高与慢性肾脏病（CKD）和急性肾损伤（AKI）患者的较高死亡率相关。我们的研究探讨了cFGF-23对CKD合并AKI（ACKD）危重症患者预后的预测准确性。
在这项多中心前瞻性观察队列研究中，检测了149例透析前合并AKI的CKD患者的尿液和血浆生物标志物。观察终点为90天死亡率和出院后90天无需透析。使用层次聚类分析、广义相加模型、Cox比例风险模型、竞争风险分析和判别评估来评估与研究终点的相关性。
在中位随访40天期间，67例（45.0%）患者在出院后第90天前死亡，39例（26.2%）进展为需要肾脏替代治疗（KFRT）的肾衰竭。层次聚类分析表明，cFGF-23水平对90天死亡率的预测能力优于其他生物标志物。较高的血清cFGF-23水平与90天死亡风险增加独立相关[风险比（HR）：2.5；95%置信区间（CI）1.5-4.1；P<0.001]。此外，将血浆cFGF-23添加到德米尔坚AKI风险评分模型中，与单独使用德米尔坚模型相比，显著改善了90天死亡率的风险预测（综合判别改善：0.06；P<0.05；95%CI 0.02-0.10）。血浆cFGF-23水平低的组预测存活患者中更多人可脱离透析（HR=0.53，95%CI，0.29-0.95，P=0.05）。
在ACKD患者中，血浆cFGF-23水平是预测90天死亡率和90天进展至KFRT的独立危险因素。结合临床风险评分，血浆cFGF-23水平可显著改善死亡风险预测。
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