Does an Increase in Serum FGF21 Level Predict 28-day Mortality of Critical Patients with Sepsis and ARDS?
Abstract BackgroundSepsis may be accompanied by acute respiratory distress syndrome (ARDS) in patients admitted to intensive care units (ICUs). It is essential to identify prognostic biomarkers in patients with sepsis and ARDS.ObjectiveDetermine whether changes in the level of serum fibroblast growth factor 21 (FGF21) can predict the 28-day mortality of ICU patients with sepsis and ARDS.MethodsConsecutive sepsis patients were divided into two groups (Sepsis+ARDS and Sepsis-only), and the Sepsis+ARDS group was further classified as survivors or non-survivors. Demographic data and comorbidities were recorded. The Sequential Organ Failure Assessment (SOFA) score and serum levels of cytokines and other biomarkers were recorded 3 times after admission. Multiple Cox proportional hazards regression was used to identify risk factors associated with 28-day mortality in the Sepsis+ARDS group.ResultsThe Sepsis+ARDS group had a greater baseline SOFA score and serum levels of cytokines and other biomarkers than the Sepsis-only group; the serum level of FGF21 was almost 2-fold greater in the Sepsis+ARDS group (P<0.05). Non-survivors in the Sepsis+ARDS group had an almost 5-fold greater level of FGF21 than survivors in this group (P<0.05). The serum level of FGF21 persistently increased from the baseline to the peak of shock and death in the non-survivors, but persistently decreased in survivors (P<0.05). Changes in the serum FGF21 level between different time points were independent risk factors for mortality.ConclusionA large increase of serum FGF21 level from baseline is associated with 28-day mortality in ICU patients with sepsis and ARDS.