{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T05:05:45Z","timestamp":1790053545706,"version":"4.0.1"},"reference-count":34,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"CIBER Cardiovascular","award":["16\/11\/00420"],"award-info":[{"award-number":["16\/11\/00420"]}]},{"name":"CIBER Cardiovascular","award":["16\/11\/00403"],"award-info":[{"award-number":["16\/11\/00403"]}]},{"name":"Unidad de Investigaci\u00f3n Cl\u00ednica y Ensayos Cl\u00ednicos INCLIVA Health Research Institute, Spanish Clinical Research Network","award":["PT13\/0002\/0031"],"award-info":[{"award-number":["PT13\/0002\/0031"]}],"id":[{"id":"https:\/\/ror.org\/01yc8eq25","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Unidad de Investigaci\u00f3n Cl\u00ednica y Ensayos Cl\u00ednicos INCLIVA Health Research Institute, Spanish Clinical Research Network","award":["PT17\/0017\/0003"],"award-info":[{"award-number":["PT17\/0017\/0003"]}],"id":[{"id":"https:\/\/ror.org\/01yc8eq25","id-type":"ROR","asserted-by":"crossref"}]},{"award":["PT13\/0002\/0031"],"award-info":[{"award-number":["PT13\/0002\/0031"]}],"id":[{"id":"https:\/\/ror.org\/01yc8eq25","id-type":"ROR","asserted-by":"publisher"}]},{"award":["PT17\/0017\/0003"],"award-info":[{"award-number":["PT17\/0017\/0003"]}],"id":[{"id":"https:\/\/ror.org\/01yc8eq25","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Fondo Europeo de Desarrollo Regional\u2014Instituto de Salud Carlos III","id":[{"id":"https:\/\/ror.org\/00ca2c886","id-type":"ROR","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/00ca2c886","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Sociedad Espa\u00f1ola de Cardiolog\u00eda","id":[{"id":"https:\/\/ror.org\/05d9ms657","id-type":"ROR","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/05d9ms657","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biomolecules"],"abstract":"<jats:p>Worsening heart failure (WHF) is a complex clinical syndrome associated with a high risk of mortality and further decompensations, characterized by fluid overload and upregulated inflammatory and fibrotic processes linked to organ dysfunction. Fibroblast growth factor 23 (FGF23) is an emerging proxy of fibrosis and may interact to influence long-term outcomes in WHF patients. This study evaluated the association between FGF23 levels and long-term outcomes in patients with WHF evaluated in the emergency department (ED). A total of 635 patients from the EAHFE registry, enrolled during 2007, 2009, and 2011, were prospectively included. FGF23 was measured in the first blood sample obtained at ED presentation. During a median follow-up of 380 days (interquartile range: 126 to 456), all-cause mortality occurred in 216 patients (34.0%), while 351 patients (55.3%) experienced the composite endpoint of death\/WHF ED reconsultation and 295 (46.5%) experienced death\/HF hospitalization. Event rates increased progressively across FGF23 levels. Patients with FGF23 above the median (48.4 pg\/mL) displayed higher rates (per 100 patient-years) of all-cause mortality (49 vs. 31, p = 0.003), death\/WHF ED reconsultation (93 vs. 65, p = 0.003), and death\/HF hospitalization (77 vs. 56, p = 0.043). In continuous analyses, each doubling of FGF23 remained significantly associated with an increased risk of all three outcomes after multivariable adjustment. These associations were consistent across clinically relevant subgroups, including those defined by age, sex, and kidney function, supporting the potential prognostic value of FGF23 within this cohort, although external validation is warranted.<\/jats:p>","DOI":"10.3390\/biom16091362","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T09:01:38Z","timestamp":1789981298000},"page":"1362","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fibroblast Growth Factor 23 and Outcomes in Acute Heart Failure"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3167-0204","authenticated-orcid":false,"given":"Arancha","family":"Mart\u00ed-Mart\u00ednez","sequence":"first","affiliation":[{"name":"Clinical Biochemistry Department, Valencia Clinical Hospital, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1672-7119","authenticated-orcid":false,"given":"Julio","family":"N\u00fa\u00f1ez","sequence":"additional","affiliation":[{"name":"Cardiology Department, Valencia Clinical Hospital, Instituto de Investigaci\u00f3n Sanitaria (INCLIVA), 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Herminio","family":"L\u00f3pez-Escribano","sequence":"additional","affiliation":[{"name":"Clinical Biochemistry Department, Valencia Clinical Hospital, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"given":"Rafael de la","family":"Espriella","sequence":"additional","affiliation":[{"name":"Cardiology Department, Valencia Clinical Hospital, Instituto de Investigaci\u00f3n Sanitaria (INCLIVA), 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Enrique","family":"Santas","sequence":"additional","affiliation":[{"name":"Cardiology Department, Valencia Clinical Hospital, Instituto de Investigaci\u00f3n Sanitaria (INCLIVA), 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0339-6704","authenticated-orcid":false,"given":"Enrique","family":"Rodriguez-Borja","sequence":"additional","affiliation":[{"name":"Clinical Biochemistry Department, Valencia Clinical Hospital, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"\u00d2scar","family":"Mir\u00f3","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital Cl\u00ednic, Instituto de Investigaciones Biom\u00e9dicas August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Pere","family":"Llorens","sequence":"additional","affiliation":[{"name":"Emergency Department, Short Stay Unit and Hospital at Home, Hospital General Dr. Balmis, Instituto de Investigaci\u00f3n Sanitaria y Biom\u00e9dica de Alicante (ISABIAL), University of Alicante, 03010 Alicante, Spain"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Aitor","family":"Alqu\u00e9zar-Arb\u00e9","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5529-5008","authenticated-orcid":false,"given":"Pablo","family":"Herrero-Puente","sequence":"additional","affiliation":[{"name":"Emergency Department, Asturias Central University Hospital, 33011 Oviedo, Spain"},{"name":"Instituto de Investigaci\u00f3n 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