TY - JOUR T1 - Fibroblast growth factor 21 predicts outcome in community-acquired pneumonia: secondary analysis of two randomised controlled trials JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.00973-2018 VL - 53 IS - 2 SP - 1800973 AU - Fahim Ebrahimi AU - Carole Wolffenbuttel AU - Claudine A. Blum AU - Christine Baumgartner AU - Beat Mueller AU - Philipp Schuetz AU - Christian Meier AU - Marius Kraenzlin AU - Mirjam Christ-Crain AU - Matthias Johannes Betz Y1 - 2019/02/01 UR - http://erj.ersjournals.com/content/53/2/1800973.abstract N2 - 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.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 ER -