Abstract
PurposeTo evaluate the value of preoperatively assessed fibroblast growth factor 23 (FGF-23) levels and to correlate FGF-23 with angiographic findings in non-occlusive mesenteric (NOMI) ischemia using a standardized scoring system.Materials and methodsBetween 2/2011 and 3/2012 a total of 865 patients (median age: 67 years) underwent cardiovascular surgery during this ethics committee approved, prospective study. 65 of these patients had clinical suspicion of NOMI and consequently underwent catheter angiography of the superior mesenteric artery. Images were assessed using a standardized reporting system (Homburg-NOMI-Score). These data were correlated to following preoperative parameters of kidney function: cystatin C, creatinine, FGF-23 and estimated glomerular filtration rate (eGFR), and outcome data (death, acute renal failure) using linear and logistic regressions, as well as nonparametric tests.ResultsSignificant correlations were found between FGF-23 and the angiographic appearance of NOMI (p = 0.03). Linear regression analysis showed no significant correlation to the severity of NOMI with creatinine (p = 0.273), cystatin C (p = 0.484), cystatin C eGFR (p = 0.914) and creatinine eGFR (p = 0.380). Logistic regression revealed a significant correlation between death and the Homburg-NOMI-Score (p<0.001), but not between development of NOMI and acute renal failure (p = 0.122). The ROC Analysis yielded an area under the curve of 0.695 (95% CI: 0.627–0.763) with a sensitivity of 0.672 and specificity of 0.658.ConclusionsFGF-23 significantly correlates with the severity of NOMI, which is in contrast to other renal function parameters. The applied scoring system allows to predict mortality in NOMI patients.
Highlights
Non occlusive mesenteric ischemia (NOMI) is a rare[1] but feared[2] disease, in which the perfusion of the intestine is limited
Linear regression analysis showed no significant correlation to the severity of NOMI with creatinine (p = 0.273), cystatin C (p = 0.484), cystatin C estimated glomerular filtration rate (eGFR) (p = 0.914) and creatinine eGFR (p = 0.380)
NOMI after cardiovascular surgery correlates with preoperative fibroblast growth factor 23 (FGF-23) levels and acute renal failure (p = 0.122)
Summary
Non occlusive mesenteric ischemia (NOMI) is a rare (incidence around 1%)[1] but feared (mortality up to 90%)[2] disease, in which the perfusion of the intestine is limited. It is believed, that a reduction of splanchnic blood flow causes an intestinal ischemia. Several risk factors for NOMI have been identified in the past including renal insufficiency[3,8,9] and coronary heart disease[1,9] These risk factors seem to influence the blood level of fibroblast growth factor 23 (FGF-23)[10]
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.