Sreekanth R Cheruku, Javier A Neyra, Hamza Mohammad, Johnny Trinh, Georgina Hernandez, Paul A Nakonezny, Michael E Jessen, Orson W Moe, Amanda A Fox
{"title":"血浆成纤维细胞生长因子23升高与心脏手术后急性肾损伤显著相关","authors":"Sreekanth R Cheruku, Javier A Neyra, Hamza Mohammad, Johnny Trinh, Georgina Hernandez, Paul A Nakonezny, Michael E Jessen, Orson W Moe, Amanda A Fox","doi":"10.1097/ALN.0000000000005605","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1000,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278735/pdf/","citationCount":"0","resultStr":"{\"title\":\"Increased Plasma Fibroblast Growth Factor 23 Significantly Associates with In-Hospital Acute Kidney Injury after Cardiac Surgery.\",\"authors\":\"Sreekanth R Cheruku, Javier A Neyra, Hamza Mohammad, Johnny Trinh, Georgina Hernandez, Paul A Nakonezny, Michael E Jessen, Orson W Moe, Amanda A Fox\",\"doi\":\"10.1097/ALN.0000000000005605\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":7970,\"journal\":{\"name\":\"Anesthesiology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":9.1000,\"publicationDate\":\"2025-06-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278735/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Anesthesiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/ALN.0000000000005605\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Anesthesiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/ALN.0000000000005605","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
Increased Plasma Fibroblast Growth Factor 23 Significantly Associates with In-Hospital Acute Kidney Injury after Cardiac Surgery.
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.
期刊介绍：
With its establishment in 1940, Anesthesiology has emerged as a prominent leader in the field of anesthesiology, encompassing perioperative, critical care, and pain medicine. As the esteemed journal of the American Society of Anesthesiologists, Anesthesiology operates independently with full editorial freedom. Its distinguished Editorial Board, comprising renowned professionals from across the globe, drives the advancement of the specialty by presenting innovative research through immediate open access to select articles and granting free access to all published articles after a six-month period. Furthermore, Anesthesiology actively promotes groundbreaking studies through an influential press release program. The journal's unwavering commitment lies in the dissemination of exemplary work that enhances clinical practice and revolutionizes the practice of medicine within our discipline.
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