Abstract 290: Fibroblast Growth Factor 21 After Out-of-Hospital Cardiac Arrest

Abstract

Introduction: Fibroblast growth factor (FGF) 21 is a novel marker of mitochondrial and cellular stress. Due to the pivotal role of mitochondria in oxidative metabolism and oxidative stress we tested the hypothesis that FGF 21 would reflect the severity of hypoxia-reperfusion injury after cardiac arrest. Methods: We measured serum concentration of FGF 21 upon ICU admission and 24, 48 and 72 hours after out-of hospital cardiac arrest (OHCA) in 112 patients. All patients had ventricular fibrillation/tachycardia (VF/VT) as initial rhythm and received targeted temperature management (TTM) of 33 or 36 °C for 24 hours. We defined 6-month Cerebral Performance Category (CPC) 1-2 as good and 3-5 as poor neurologic outcome. We used samples from 40 age- and gender-matched non-critically ill emergency room patients as controls. Group differences were assessed with the Mann Whitney U test and temporal differences with Friedman’s ANOVA and Wilcoxon signed ranks test. Results: The median (inter-quartile range, IQR) FGF 21 concentration at ICU admission was 790 (370-1600) pg/ml and the peak value was 1200 (460-2500) pg/ml at 48 hours. Compared to the ICU admission values, the concentrations in control samples [250 (94-910) pg/ml] were significantly lower (P < 0.001). The ICU admission FGF 21 levels were higher in patients with poor neurologic outcome (P = 0.04) and they correlated weakly with the time from collapse to return of spontaneous circulation (Spearman’s rho 0.23). Serum FGF 21 levels changed over time (P < 0.001). Figure 1 presents serum FGF 21 median levels with IQR (box) and 10-90 percentiles (whiskers). Conclusion: Patients after OHCA have elevated FGF 21 levels after successful resuscitation. Higher ICU admission FGF 21 levels associate with poor 6-month neurologic outcome.