title: Fibroblast growth factor 23 (FGF-23) is an early predictor of mortality in patients with cardiac arrest.
abstract: BACKGROUND
  Post-cardiac arrest management has seen significant advances with profound improvements in survival and neurologic outcome. However, early prognostication after return of spontaneous circulation remains most challenging. Biomarkers have evolved as helpful tools in identifying patients who are at increased risk of adverse outcome. While fibroblast growth factor 23 (FGF-23) has recently emerged as a promising predictor of mortality in patients with cardiogenic shock, its role in risk stratification in post-resuscitation management remains unresolved.
  
  
  METHODS
  This study included 90 patients who had been resuscitated and transferred to the ICU of the University Hospital Heidelberg. Survivors and non-survivors were retrospectively analyzed for known prognostic biomarkers as well as FGF-23 serum levels 24h and 72 h post cardiac arrest (CA).
  
  
  RESULTS
  FGF-23 levels were significantly elevated in non-survivors compared to survivors. ROC analysis of FGF-23 levels at 24h and 72 h post CA yielded an AUC of 0.759 and 0.726, respectively, for prediction of overall survival after 6 months. FGF-23 levels remained as significant prognosticators after adjusting for age, renal function, and initial cardiac rhythm. FGF-23 levels did not show significant differences in patient outcome after stratification for cardiac origin of CA or left ventricular dysfunction. Furthermore, FGF-23 levels were moderately predictive of poor neurologic outcome in ROC analysis on day 1 and day 3 post CA with an AUC of 0.738 and 0.687, respectively.
  
  
  CONCLUSIONS
  This study demonstrates elevated FGF-23 serum levels to be potentially helpful in prediction of mortality and poor neurological outcome as early as 24h post cardiac arrest.
authors.affiliation: Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Spaich
authors.affiliation: Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zelniker
authors.affiliation: Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Endres
authors.affiliation: Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Stiepak
authors.affiliation: Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Uhlmann
authors.affiliation: Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany.
authors.forename: Raffi
authors.initials: R
authors.lastname: Bekeredjian
authors.affiliation: Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chorianopoulos
authors.affiliation: Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Giannitsis
authors.affiliation: Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Backs
authors.affiliation: Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany.
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Katus
authors.affiliation: Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany. Electronic address: michael.preusch@med.uni-heidelberg.de.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Preusch
mesh_terms: D015415:Biomarkers / Q000097:blood*; D016887:Cardiopulmonary Resuscitation; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000097:blood* / Q000401:mortality*; D010865:Pilot Projects; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D015415:Biomarkers; C000717427:FGF23 protein, human; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23
keywords: Biomarker; Cardiac arrest; FGF-23; Mortality; Neurological outcome