Abstract
Acute systemic inflammatory conditions are accompanied by profound alterations of metabolism. However, the role of fibroblast growth factor 21 (FGF21), a recently identified central regulator of metabolism, is largely unknown in community-acquired pneumonia (CAP). This study aims to characterise the pattern of FGF21 in pneumonia and associations with disease severity and outcome.
This is a secondary analysis of two independent multicentre randomised controlled trials in patients presenting to the emergency department with CAP. Primary and secondary efficacy parameters included 30-day mortality, length of hospital stay, time to clinical stability and duration of antibiotic treatment.
A total of 509 patients were included in the analysis. FGF21 levels at admission strongly correlated with disease severity, as measured by the Pneumonia Severity Index. Increased levels of FGF21 were associated with prolonged time to clinical stability, antibiotic treatment and hospitalisation. FGF21 levels at admission were significantly higher in nonsurvivors than in survivors, yielding a 1.61-fold increased adjusted odds ratio of 30-day mortality (95% CI 1.21–2.14; p=0.001). Moreover, FGF21 was found to identify patients for 30-day mortality with superior discriminative power compared with routine diagnostic markers.
Moderate-to-severe CAP patients with higher levels of FGF21 were at increased risk for clinical instability, prolonged hospitalisation and 30-day all-cause mortality.
Abstract
Fibroblast growth factor 21 predicts higher risk for clinical instability and 30-day mortality in moderate-to-severe community-acquired pneumonia http://ow.ly/8LVe30mWrjH
Footnotes
This article has supplementary material available from erj.ersjournals.com
The two trials analysed in this study are registered at ClinicalTrials.gov with identifier number NCT00973154 (STEP) and at the ISRCTN Registry with identifier ISRCTN04176397 (ProCAP). Individual participant data that underlie the results reported in this article, after de-identification (text, tables, figures and appendices, study protocols) will be available to investigators whose proposed use of the data has been approved by an independent review committee (“learned intermediary”) identified for the purpose of an individual participant data meta-analysis, beginning 9 months and ending 36 months after article publication. Proposals should be directed to the corresponding author. To gain access, data requestors will need to sign a data access agreement.
Author contributions: C. Wolffenbuttel, F. Ebrahimi, M. Christ-Crain and M.J. Betz were involved in the conception, hypothesis delineation, design of the study and interpretation of data. F. Ebrahimi and M.J. Betz performed the measurements of FGF21. B. Mueller, C.A. Blum, P. Schuetz, C. Meier and M. Kraenzlin contributed data and were involved in revising the manuscript critically. All authors approved the final version to be published. F. Ebrahimi and M.J. Betz had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Conflict of interest: F. Ebrahimi has nothing to disclose.
Conflict of interest: C. Wolffenbuttel has nothing to disclose.
Conflict of interest: C.A. Blum has nothing to disclose.
Conflict of interest: C. Baumgartner has nothing to disclose.
Conflict of interest: B. Mueller has nothing to disclose.
Conflict of interest: P. Schuetz has nothing to disclose.
Conflict of interest: C. Meier has nothing to disclose.
Conflict of interest: M. Kraenzlin has nothing to disclose.
Conflict of interest: M. Christ-Crain has nothing to disclose.
Conflict of interest: M.J. Betz has nothing to disclose.
Support statement: This study was supported by grants from the Swiss National Science Foundation (SNSF PP0P3_123346) and by the Nora van Meeuwen Häfliger Stiftung and the Gottfried & Julia Bangerter-Rhyner Foundation to M. Christ-Crain. F. Ebrahimi was supported by the Swiss Academy of Medical Sciences and the Gottfried & Julia Bangerter-Rhyner Foundation, and by Research Funds of the University of Basel. M.J. Betz was supported by a grant from the Goldschmidt-Jacobson Foundation, Basel. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received May 24, 2018.
- Accepted November 11, 2018.
- Copyright ©ERS 2019
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