Fibroblast growth factor 23 in acute burn patients: Novel insights from an intact-form assay

Fibroblast growth factor 23 (FGF23) is a key regulator in phosphate and vitamin D metabolism When measured with c-terminal assay, it has been shown to be increased following burn. Progress in understanding FGF23 physiology has emphasized the importance of assessing the intact form of FGF23.

The present cohort study is a complementary analysis of a previously published work. Patients >18 years, admitted within 24h after injury with burn surface area (BSA) >10% were included. C-terminal (c-term) and intact (i) FGF23 assay were performed at admission and every week during 4 weeks of follow-up. Inflammation and iron status were assessed at the same time points.

Twenty patients were initially included and 12 were followed until day 28. The c-term FGF23 tended to gradually increase during the 4 weeks of follow-up while iFGF23 was quite stable into normal ranges. Iron status showed a typical inflammatory profile. C-term FGF23 was significantly positively correlated with c-reactive protein (CRP) and negatively correlated with iron levels. iFGF23 was not correlated with CRP or iron.

FGF23 status following burn is characterized by a dissociation between c-term FGF23 and iFGF23. The hypothesis of an increased cleavage may be raised. Respective role of inflammation and iron levels in such deregulation need to be specified. Both c-term and intact assays should be performed in further studies aiming to increase knowledge on FGF23 regulation and effects in burn patients.