Fibroblast growth factor 23 in acute myocardial infarction complicated by cardiogenic shock: a biomarker substudy of the Intraaortic Balloon Pump in Cardiogenic Shock II IABP-SHOCK II trialReport as inadecuate




Fibroblast growth factor 23 in acute myocardial infarction complicated by cardiogenic shock: a biomarker substudy of the Intraaortic Balloon Pump in Cardiogenic Shock II IABP-SHOCK II trial - Download this document for free, or read online. Document in PDF available to download.

Critical Care

, 18:713

First Online: 21 December 2014Received: 05 September 2014Accepted: 08 December 2014

Abstract

IntroductionCardiogenic shock CS is the leading cause of death in patients hospitalized with acute myocardial infarction AMI. Biomarkers might help in risk stratification and understanding of pathophysiology. Preliminary data suggests that patients with CS face a profound increase in the osteocyte-derived hormone fibroblast growth factor 23 FGF-23, which acts as a negative regulator of serum phosphate levels. The present study aimed to assess the predictive role of FGF-23 for clinical outcome in a large cohort of CS patients with and without renal dysfunction.

MethodsIn the randomized Intraaortic Balloon Pump in Cardiogenic Shock II IABP-SHOCK II trial, 600 patients with CS complicating AMI were assigned to therapy with or without IABP. Our predefined biomarker substudy included 182 patients. Blood sampling was performed in a standardized procedure at three different time points day 1 day of admission, day 2 and day 3. Differences in outcome of patients with FGF-23 levels < and > median were compared by log-rank testing. Stepwise logistic regression modeling was performed to identify predictors of death at 30 days and Cox regression analysis for time to death during the first year.

ResultsAt all three time points, nonsurvivors had significantly higher FGF-23 levels compared to survivors P <0.001 for all. Patients with FGF-23 levels above the median 395 RU-mL interquartile range 102;2,395 were characterized by an increased 30-day mortality and 1-year mortality. In multivariable analysis FGF-23 levels remained independent predictors for 30-day odds ratio per 10log 1.80, 95% confidence interval CI 1.11 to 2.92; P = 0.02 and 1-year mortality hazard ratio 1.50, 95% CI 1.11 to 2.04, P = 0.009. After stratifying the patients according to their baseline serum creatinine levels, the negative prognostic association of increased FGF-23 was only significant in those with serum creatinine greater than median.

ConclusionsIn CS, high levels of FGF-23 are independently related to a poor clinical outcome. However, this prognostic association appears only to apply in patients with impaired renal function.

Trial registrationClinicalTrials.gov NCT00491036. Registered 22 June 2007.

AbbreviationsAMIacute myocardial infarction

AUCarea under the curve

CADcoronary artery disease

CIconfidence interval

CKDchronic kidney disease

CScardiogenic shock

EFejection fraction

FGF-23fibroblast growth factor 23

HRhazard ratio

IABPintraaortic balloon pump

IQRinterquartile range

ORodds ratio

PCIpercutaneous coronary intervention

RAASrenin-angiotensin-aldosterone system

Electronic supplementary materialThe online version of this article doi:10.1186-s13054-014-0713-8 contains supplementary material, which is available to authorized users.

Georg Fuernau, Janine Pöss contributed equally to this work.

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Author: Georg Fuernau - Janine Pöss - Daniel Denks - Steffen Desch - Gunnar H Heine - Ingo Eitel - Sarah Seiler - Suzanne de Wah

Source: https://link.springer.com/







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