Intact fibroblast growth factor 23 levels and outcome prediction in patients with acute heart failure

Abstract

Elevated fibroblast growth factor 23 (FGF23) levels are associated with adverse outcome in populations with cardiovascular disease and chronic kidney failure. It is unclear if FGF23 has significance in prognosis estimation in patients with acute heart failure (HF) when compared to traditional risk estimation tools. Serum levels of intact FGF23 were assessed in 139 patients admitted to the Intermediate Care Unit of a tertiary hospital for acute HF. Patients were followed-up for one year. After exclusion of patients who were lost to follow-up, data outliers, and patients with sampling errors, the final study cohort comprised 133 patients. The Seattle Heart Failure (SHF) Model was used to estimate one-year survival. FGF23 levels correlated with HF severity and were strongly associated with one-year mortality. Associations between one-year outcome and FGF23, assessed on day 1 after admission, were still evident after multivariable adjustment (OR 15.07; 95%CI 1.75–129.79; p = 0.014). FGF23 levels predicted the one-year outcome with similar accuracy as the SHF Model, both if assessed on day 1 and on day 2 after admission (FGF23d1: AUC 0.784; 95%CI 0.669–0.899; FGF23d2: AUC 0.766; 95%CI 0.631–0.901; SHF: AUC 0.771; 95%CI 0.651–0.891). The assessment of FGF23 in patients with acute HF might help identify high-risk patients that are more prone to complications, need a closer follow-up and more aggressive treatment.

Fibroblast Growth Factor 23 and Outcome Prediction in Patients with Acute Myocardial Infarction

“…To account for the impact of HF, it is common practice to adjust for LV ejection fraction when assessing outcomes. However, we [9] and others [38] have shown before that FGF23 does not increase linearly with declining ejection fraction. Considering that patients with HF and preserved ejection fraction had higher FGF23 levels compared with control patients and that FGF23 was also predictive for adverse cardiovascular outcome in these patients [39], the mere adjustment for ejection fraction does not fully account for the impact of HF when assessing outcomes.…”

“…Numerous studies have shown associations between FGF23 and cardiovascular outcome [8,9,15,[25][26][27]. While strong associations with cardiovascular morbidity and mortality have been reported in patients with HF, less is known about associations between FGF23 and outcome in patients with MI.…”

“…Increased FGF23 levels have been associated not only with structural myocardial damage, including impaired left-ventricular (LV) function and adverse LV remodeling [1][2][3][4], but also with alterations in myocyte calcium handling [5], upregulation of the renin-angiotensin system [6], and promotion of vascular calcification [7]. Importantly, FGF23 may predict clinical outcome in patients with acute and established heart failure (HF) [8,9].…”

The Role of Vitamin D3 as an Independent Predicting Marker for One-Year Mortality in Patients with Acute Heart Failure

“…The baseline characteristics of the population were previously described [ 20 ]. In short, 139 patients with acute HF who were admitted to the Intermediate Care Unit of University Hospital Aachen were included in the initial study.…”

“…In addition to well-established models of projected survival, such as the SHF model, aiming to standardize prognosis estimation in clinical practice, reliable prognostic biomarkers could potentially facilitate prognosis estimation and, thus, allow treatment stratification. We have recently shown that elevated levels of fibroblast growth factor 23 (FGF23), secreted in response to elevated phosphate levels by osteoblasts and osteocytes, predicted one-year mortality with similar accuracy as the SHF model in patients with acute HF [ 20 ]. Interestingly, FGF23 is a potent suppressor of vitamin D, inhibiting the conversion of 25-OH-vitamin D 3 to its active form, 1,25-(OH) 2 -vitamin D 3 .…”