RT Journal Article SR Electronic T1 Fibroblast Growth Factor-21 Predicts Outcome in Community-Acquired Pneumonia Secondary Analysis of two Randomized Controlled Trials JF European Respiratory Journal JO Eur Respir J FD European Respiratory Society SP 1800973 DO 10.1183/13993003.00973-2018 A1 Fahim Ebrahimi A1 Carole Wolffenbuttel A1 Claudine A. Blum A1 Christine Baumgartner A1 Beat Mueller A1 Philipp Schuetz A1 Christian Meier A1 Marius Kraenzlin A1 Mirjam Christ-Crain A1 Matthias Johannes Betz YR 2018 UL http://erj.ersjournals.com/content/early/2018/12/05/13993003.00973-2018.abstract AB Acute systemic inflammatory conditions come along with profound alterations of metabolism. However the role of FGF21, a recently identified central regulator of metabolism is largely unknown in community-acquired pneumonia.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 multicenter randomised controlled trials in patients presenting to the emergency department with community-acquired pneumonia. 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 to disease severity, as measured by 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 non-survivors 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 to than routine diagnostic markers.In moderate-to-severe CAP patient with higher levels of FGF21 were at increased risk for clinical instability, prolonged hospitalisation and 30-day all-cause mortality.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Ebrahimi has nothing to disclose.Conflict of interest: Dr. Blum has nothing to disclose.Conflict of interest: Dr. Baumgartner has nothing to disclose.Conflict of interest: Dr. Meier has nothing to disclose.Conflict of interest: Dr. Kraenzlin has nothing to disclose.Conflict of interest: Dr. Christ-Crain has nothing to disclose.Conflict of interest: Dr. Betz has nothing to disclose.Conflict of interest: Dr. Müller has nothing to disclose.Conflict of interest: Ms. Wolffenbuttel has nothing to disclose.Conflict of interest: Dr. Schütz has nothing to disclose.