Thein Onn Shaun, Ali Naeman Akbar, Mahida Rahul Y, Dancer Rachel C A, Ostermann Marlies, Amrein Karin, Martucci Gennaro, Scott Aaron, Thickett David R, Parekh Dhruv
Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Level 2 Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, UK.
Warwick Hospital, Warwick CV34 5BW, UK.
Biology (Basel). 2023 Feb 14;12(2):309. doi: 10.3390/biology12020309.
Fibroblast Growth Factor (FGF23) is an endocrine hormone classically associated with the homeostasis of vitamin D, phosphate, and calcium. Elevated serum FGF23 is a known independent risk factor for mortality in chronic kidney disease (CKD) patients. We aimed to determine if there was a similar relationship between FGF23 levels and mortality in critically ill patients.
Plasma FGF23 levels were measured by ELISA in two separate cohorts of patients receiving vitamin D supplementation: critical illness patients (VITdAL-ICU trial, = 475) and elective oesophagectomy patients (VINDALOO trial, = 76). Mortality data were recorded at 30 and 180 days or at two years, respectively. FGF23 levels in a healthy control cohort were also measured ( = 27).
Elevated FGF23 (quartile 4 vs. quartiles 1-3) was associated with increased short-term (30 and 180 day) mortality in critical illness patients ( < 0.001) and long-term (two-year) mortality in oesophagectomy patients ( = 0.0149). Patients who died had significantly higher FGF23 levels than those who survived: In the critical illness cohort, those who died had 1194.6 pg/mL (range 0-14,000), while those who survived had 120.4 pg/mL (range = 15-14,000) ( = 0.0462). In the oesophagectomy cohort, those who died had 1304 pg/mL (range = 154-77,800), while those who survived had 644 pg/mL (range = 179-54,894) ( < 0.001). This was found to be independent of vitamin D or CKD status (critical illness = 0.3507; oesophagectomy = 0.3800). FGF23 levels in healthy controls were similar to those seen in oesophagectomy patients ( = 0.4802).
Elevated baseline serum FGF23 is correlated with increased mortality in both the post-oesophagectomy cohort and the cohort of patients with critical illness requiring intensive care admission. This was independent of vitamin D status, supplementation, or CKD status, which suggests the presence of vitamin D-independent mechanisms of FGF23 action during the acute and convalescent stages of critical illness, warranting further investigation.
成纤维细胞生长因子（FGF23）是一种经典的内分泌激素，与维生素D、磷酸盐和钙的稳态相关。血清FGF23升高是慢性肾脏病（CKD）患者死亡的已知独立危险因素。我们旨在确定FGF23水平与危重症患者死亡率之间是否存在类似关系。
通过酶联免疫吸附测定（ELISA）法测量了两个分别接受维生素D补充的患者队列的血浆FGF23水平：危重症患者（VITdAL-ICU试验，n = 475）和择期食管切除术患者（VINDALOO试验，n = 76）。分别在30天和180天或两年时记录死亡率数据。还测量了一个健康对照队列的FGF23水平（n = 27）。
FGF23升高（四分位数4与四分位数1 - 3相比）与危重症患者的短期（30天和180天）死亡率增加相关（P < 0.001），与食管切除术患者的长期（两年）死亡率增加相关（P = 0.0149）。死亡患者的FGF23水平显著高于存活患者：在危重症队列中，死亡患者的FGF23水平为1194.6 pg/mL（范围0 - 14,000），而存活患者为120.4 pg/mL（范围 = 15 - 14,000）（P = 0.0462）。在食管切除术队列中，死亡患者的FGF23水平为1304 pg/mL（范围 = 154 - 77,800），而存活患者为644 pg/mL（范围 = 179 - 54,894）（P < 0.001）。发现这与维生素D或CKD状态无关（危重症患者P = 0.3507；食管切除术患者P = 0.
