Abstract
IntroductionSeveral scoring systems have been developed to predict postoperative mortality and complications in patients undergoing cardiac surgery. However, these computer-based calculations are time- and cost-intensive. A simple but highly predictive test for postoperative risk would be of clinical benefit with respect to increasingly scarce hospital resources. We therefore assessed the predictive power of fibroblast growth factor 23 (FGF23) measurement compared with an established scoring system.MethodsWe conducted a prospective interdisciplinary observational study at the Saarland University Medical Centre that included 859 patients undergoing elective cardiac surgery between January 2010 and March 2011 with a median follow-up after discharge of 822 days. We compared a single preoperative measurement of FGF23 as a prognostic tool with the 18 parameters comprising EuroSCORE II with respect to postoperative mortality, acute kidney injury, non-occlusive mesenteric ischemia, clinical course and long-term outcome.ResultsPreoperative FGF23 levels were highly predictive of postoperative outcome and complications. The predictive value of FGF23 for mortality in the receiver operating characteristic curve was greater than the EuroSCORE II (area under the curve: 0.800 versus 0.725). Moreover, preoperative FGF23 independently predicted postoperative acute kidney injury and non-occlusive mesenteric ischemia comparably to the EuroSCORE II. Finally, FGF23 was found to be an independent predictor of clinical course parameters, including duration of surgery, ventilation time and length of stay.ConclusionsIn patients undergoing elective cardiac surgery, a simple preoperative FGF23 measurement is a powerful indicator of surgical mortality, postoperative complications and long-term outcome. Its utility compares to the widely used EuroSCORE II.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0925-6) contains supplementary material, which is available to authorized users.
Highlights
Several scoring systems have been developed to predict postoperative mortality and complications in patients undergoing cardiac surgery
The predictive value of fibroblast growth factor 23 (FGF23) for mortality in the receiver operating characteristic curve was greater than the EuroSCORE II
In patients undergoing elective cardiac surgery, a simple preoperative FGF23 measurement is a powerful indicator of surgical mortality, postoperative complications and long-term outcome
Summary
Several scoring systems have been developed to predict postoperative mortality and complications in patients undergoing cardiac surgery. These computer-based calculations are time- and cost-intensive. Fibroblast growth factor 23 (FGF23) has recently emerged as a powerful biomarker for adverse outcome in patients with or without chronic kidney disease (CKD) [8,9]. An association between FGF23 levels, impaired left ventricular (LV) function and atrial fibrillation has been reported in patients with CKD and even in patients without renal failure [18,19]. FGF23 predicts risk of cardiovascular mortality and progression to congestive cardiac failure in patients with stable coronary artery disease [9]
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