A Combined Biomarker That Includes Plasma Fibroblast Growth Factor 23, Erythropoietin, and Klotho Predicts Short- and Long-Term Morbimortality and Development of Chronic Kidney Disease in Critical Care Patients with Sepsis: A Prospective Cohort
Luis Toro,
Verónica Rojas,
Carolina Conejeros,
Patricia Ayala,
Alfredo Parra-Lucares,
Francisca Ahumada,
Paula Almeida,
María Fernanda Silva,
Karin Bravo,
Catalina Pumarino,
Ana María Tong,
María Eugenia Pinto,
Carlos Romero,
Luis Michea
Affiliations
Luis Toro
Division of Nephrology, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago 8380456, Chile
Verónica Rojas
Centro de Investigación Clínica Avanzada, Hospital Clínico Universidad de Chile, Santiago 8380456, Chile
Carolina Conejeros
Division of Nephrology, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago 8380456, Chile
Patricia Ayala
Centro de Investigación Clínica Avanzada, Hospital Clínico Universidad de Chile, Santiago 8380456, Chile
Alfredo Parra-Lucares
Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago 8380456, Chile
Francisca Ahumada
Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago 8380456, Chile
Paula Almeida
Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago 8380456, Chile
María Fernanda Silva
Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago 8380456, Chile
Karin Bravo
Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago 8380456, Chile
Catalina Pumarino
Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago 8380456, Chile
Ana María Tong
Clinical Laboratory, Hospital Clínico Universidad de Chile, Santiago 8380456, Chile
María Eugenia Pinto
Clinical Laboratory, Hospital Clínico Universidad de Chile, Santiago 8380456, Chile
Carlos Romero
Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago 8380456, Chile
Luis Michea
Division of Nephrology, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago 8380456, Chile
Acute Kidney Injury (AKI) is a frequent complication in intensive care unit (ICU) patients that increases mortality and chronic kidney disease (CKD) development. AKI is associated with elevated plasma fibroblast growth factor 23 (FGF23), which can be modulated by erythropoietin (EPO) and Klotho. We aimed to evaluate whether a combined biomarker that includes these molecules predicted short-/long-term outcomes. We performed a prospective cohort of ICU patients with sepsis and previously normal renal function. They were followed during their inpatient stay and for one year after admission. We measured plasma FGF23, EPO, and Klotho levels at admission and calculated a combined biomarker (FEK). A total of 164 patients were recruited. Of these, 50 (30.5%) had AKI at admission, and 55 (33.5%) developed AKI within 48 h. Patients with AKI at admission and those who developed AKI within 48 h had 12- and 5-fold higher FEK values than non-AKI patients, respectively. Additionally, patients with higher FEK values had increased 1-year mortality (41.9% vs. 18.6%, p = 0.003) and CKD progression (26.2% vs. 8.3%, p = 0.023). Our data suggest that the FEK indicator predicts the risk of AKI, short-/long-term mortality, and CKD progression in ICU patients with sepsis. This new indicator can improve clinical outcome prediction and guide early therapeutic strategies.