FGF-23 in acute heart failure with reduced ejection fraction: is it useful to predict admissions?
A Bollas Becerra, M Cortes Garcia, L De Miguel Garcia, O Lorenzo Gonzalez, J Lumpuy-Castillo, C S Garcia-Talavera, M B Arroyo Rivera, J A Esteban Chapel, J M Romero Otero, I Mahillo-Fernandez, M Taibo-Urquia, A M Pello Lazaro, M L Casaus Gonzalez, J Tunon FernandezAbstract
Abstract
Introduction and objectives: New biomarkers are emerging in heart failure (HF), whose prognostic value has not yet been established. Our objective was to analyze the prognostic value of some of these biomarkers, specifically fibroblast growth factor 23 (FGF-23), which is involved in calcium-phosphorus metabolism, with regard to the risk of hospitalization for HF in patients with acute HF with reduced ejection fraction (HFrEF).
Methods
A prospective, single-center study was conducted, including 104 patients with decompensated rHF. At admission, serum and plasma samples were collected and biomarkers, including FGF-23, were analyzed. Univariate Cox regression analysis was performed to identify the association with all-cause mortality and rehospitalization for HF, and diagnostic accuracy was evaluated using ROC curves.
Results
A total of 104 patients (78% male, mean age 66.7 years) with a mean LVEF of 21% and treated with the drugs listed in the table were included. After a median follow-up of 23.5 months, there were 21 readmissions for HF and 20 deaths from any cause. suPAR was significantly associated with new hospitalization for HF (HR 2.13 [95% CI 1.36-3.33]) and all-cause mortality (HR 2.20 [95% CI 1.45-3.39]). Plotting ROC curves (figure), the AUCs for new hospitalization and mortality were 0.62 (95% CI 0.51-0.71) and 0.65 (95% CI 0.55-0.74), significantly higher than the AUC of NT-proBNP for hospitalization (p 0.02) but not for mortality (p 0.93). Analyzing the ROC curves, cutoff points of 2050 RU/mL are proposed for a PPV of 57% and NPV of 83% for mortality, and 2020 RU/mL for a PPV of 60% and NPV of 85% for new hospitalization, calculating the values with a 20% incidence of both endpoints.
Conclusions
FGF-23 showed modest prognostic value for rehospitalization due to HF and death from any cause in patients with decompensated HFpEF, significantly exceeding the diagnostic accuracy of NT-proBNP in terms of hospitalization, but not mortality. Larger studies will be necessary to validate these findings, propose alternative cut-off points, and define the role of suPAR in different patient subgroups.ROC curves for mortality and hospFor image description, please refer to the figure legend and surrounding text.