Correlation between serum galectin-3 and fibroblast growth factor 23 and clinical prognosis of patients undergoing heart valve replacement surgery under cardiopulmonary bypass
Correlation between serum galectin-3 and fibroblast growth factor 23 and clinical prognosis of patients undergoing heart valve replacement surgery under cardiopulmonary bypass
Objective To investigate the correlation between serum galectin-3(Gal-3)and fibroblast growth factor 23(FGF-23)and clinical prognosis of patients undergoing heart valve replacement surgery under cardiopulmonary bypass(CPB).Method A total of 521 patients who underwent heart valve replacement surgery under CPB in the Affiliated Hospital of Guilin Medical University from January 2021 to December 2023 were selected.Serum Gal-3 and FGF-23 levels were measured before surgery,and all patients received regular follow-up.Based on the 6-month follow-up after the surgery,the patients were divided into the mortality group and survival group.Baseline data,serum Gal-3 and FGF-23 levels were compared between the two groups.The correlation between serum Gal-3 and FGF-23 and clinical prognosis of patients undergoing heart valve replacement surgery under CPB was analyzed using a restricted cubic spline model(RCS).The influencing factors of clinical prognosis were analyzed using Cox regression analysis.Receiver operating characteristic(ROC)curves were plotted to analyze the predictive value of serum Gal-3 and FGF-23 on clinical prognosis of patients undergoing heart valve replacement surgery under CPB.Decision curves were plotted to verify the clinical application value of the predictive model.Results During the 6-month follow-up period,after excluding 19 patients who did not complete the follow-up or died from other reasons,a total of 502 patients completed the follow-up,of which 31 died,with a mortality rate of 6.18％.The level of plasma N-terminal pro brain natriuretic peptide(NT-proBNP),serum Gal-3,FGF-23 levels,and New York Heart Association(NYHA)functional class Ⅲ patients in the mortality group were higher than that in the survival group(P＜0.05).RCS analysis indicated that the clinical prognosis of patients undergoing heart valve replacement surgery under CPB showed a non-linear dose-response relationship with serum Gal-3 and FGF-23 levels(P＜0.05).When preoperative serum Gal-3 and FGF-23 levels were greater than 26.09 μg/L and 754.19ng/L,respectively,the mortality risk of patients undergoing heart valve replacement surgery under CPB increased with the increase of indicator levels.Cox regression analysis showed that serum Gal-3,FGF-23,plasma NT-proBNP and NYHA heart function grading were the influencing factors of clinical prognosis in patients undergoing heart valve replacement surgery under CPB(P＜0.05).ROC curves were drawn,and the area under the curve(AUC)of serum Gal-3 and FGF-23 alone and in combination for predicting clinical prognosis was greater than 0.7,with a higher AUC predicted in combination(P＜0.05).Decision curve showed that compared to the application of each indicator separately,the decision curve drawn with the assistance of serum Gal-3 and FGF-23 combined with plasma NT-proBNP and NYHA heart function grade Ⅲ had a higher net benefit rate,with a maximum net benefit rate of 0.062.Conclusion Serum Gal-3 and FGF-23 levels are closely related to the clinical prognosis of patients undergoing heart valve replacement surgery under CPB.The higher the preoperative levels of serum Gal-3 and FGF-23,the greater the risk of mortality.Serum Gal-3 and FGF-23 are the influencing and predictive factors for the clinical prognosis of patients undergoing heart valve replacement surgery under CPB,and their combined predictive value with plasma NT-proBNP and NYHA heart function grading is higher.
维普
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