血浆成纤维细胞生长因子23升高与心脏手术后院内急性肾损伤显著相关。
Increased Plasma Fibroblast Growth Factor 23 Significantly Associates with In-Hospital Acute Kidney Injury after Cardiac Surgery.
作者信息
Cheruku Sreekanth R, Neyra Javier A, Mohammad Hamza, Trinh Johnny, Hernandez Georgina, Nakonezny Paul A, Jessen Michael E, Moe Orson W, Fox Amanda A
机构信息
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center.
Division of Nephrology, Department of Medicine, University of Alabama at Birmingham.
出版信息
Anesthesiology. 2025 Jun 9. doi: 10.1097/ALN.0000000000005605.
BACKGROUND
Acute kidney injury (AKI) occurs in 20-30% of cardiac surgery patients and is most often classified as mild. A prior study reported that intact fibroblast growth factor 23 (iFGF23) and C-terminal fibroblast growth factor 23 (cFGF23) measured after cardiopulmonary bypass (CPB) were associated with severe AKI after cardiac surgery, but did not analyze the association between iFGF23 and all-stage AKI. The primary aim of our study was to determine whether FGF23 biomarker measurements six hours following CPB were associated with all-stage AKI after cardiac surgery.
METHODS
This prospective observational study included 173 patients undergoing non-emergent coronary artery bypass graft (CABG) and/or valve surgery on CPB. The primary study outcome was all-stage postoperative in-hospital AKI defined using the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria through postoperative day seven or earlier if hospital stay was less than 7 days. Plasma iFGF23 and cFGF23 were measured six hours after the end of CPB.
RESULTS
A total of 32 patients developed in-hospital postoperative AKI (18.5%) by the seventh post-operative day. The incidence of AKI was 18.5% in CABG patients, 14.3% in valve surgery patients, and 41.2% in combined CABG-valve patients. A 2-fold increase in cFGF23 was associated with 1.57 greater predicted odds of developing in-hospital postoperative AKI (OR 1.57; 95% CI: 1.26 - 1.96; p<0.0001). This association remained significant after adjusting for clinical covariates (OR 1.40; 95% CI: 1.10 - 1.77; p=0.006) and after adjusting for preoperative Cleveland Clinic Score (OR 1.54; 95% CI: 1.22 - 1.95; p=0.0003). A 2-fold increase in iFGF23 was associated with 1.59 greater predicted odds of developing in-hospital postoperative AKI (OR 1.59; 95% CI: 1.08 - 2.35; p=0.018).
CONCLUSIONS
Early postoperative measurements of cFGF23 and iFGF23 are associated with all-stage AKI after cardiac surgery. The utility of these biomarkers for risk-classification in cardiac surgery patients remains to be determined.
背景
急性肾损伤（AKI）发生于心外科手术患者中的比例为20% - 30%，且大多被归类为轻度。先前一项研究报告称，体外循环（CPB）后测得的完整成纤维细胞生长因子23（iFGF23）和C端成纤维细胞生长因子23（cFGF23）与心脏手术后的严重AKI相关，但未分析iFGF23与所有阶段AKI之间的关联。我们研究的主要目的是确定CPB后6小时的FGF23生物标志物测量值是否与心脏手术后的所有阶段AKI相关。
方法
这项前瞻性观察性研究纳入了173例接受非急诊冠状动脉搭桥术（CABG）和/或CPB下瓣膜手术的患者。主要研究结局是术后住院期间所有阶段的AKI，根据《改善全球肾脏病预后组织（KDIGO）》血清肌酐标准定义，直至术后第7天，若住院时间少于7天则为更早时间点。在CPB结束后6小时测量血浆iFGF23和cFGF23。
结果
共有32例患者在术后第7天出现术后住院期间AKI（18.5%）。CABG患者中AKI的发生率为18.5%，瓣膜手术患者中为14.3%，CABG - 瓣膜联合手术患者中为41.2%。cFGF23升高2倍与术后住院期间发生AKI的预测几率高1.57倍相关（比值比[OR]1.57；95%置信区间[CI]：1.26 - 1.96；p<0.0001）。在调整临床协变量后（OR 1.40；95% CI：1.10 - 1.77；p = 0.006）以及调整术前克利夫兰诊所评分后（OR 1.54；95% CI：1.22 - 1.95；p = 0.0003），这种关联仍然显著。iFGF23升高2倍与术后住院期间发生AKI的预测几率高1.59倍相关（OR 1.59；95% CI：1.08 - 2.35；p = 0.018）。
结论
术后早期测量cFGF23和iFGF23与心脏手术后所有阶段的AKI相关。这些生物标志物在心脏手术患者风险分类中的效用仍有待确定。
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