BACKGROUND: There have been recent studies on fibroblast growth factor 23 (FGF23) and acute ischaemic stroke (AIS), but some of the results were conflicting. Therefore, the objective of this study was to assess whether baseline FGF23 was associated with the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) in AIS patients. METHODS: This study enrolled 394 patients with AIS and followed for a median period of 43 months. 130 people who underwent health check-ups in our hospital were selected as the control group. The study endpoint was the first occurrence of MACCE outside the hospital. Serum FGF23 levels were quantified using an enzyme-linked immunosorbent assay. RESULTS: Serum FGF23 levels were found to be significantly higher in the AIS group than in the control group (525.14±167.40 vs 338.62±161.71, P<0.05). Furthermore, serum FGF23 levels were observed to be elevated in the MACCE group in comparison to the no MACCE group (646.09±164.05 vs 491.87±152.54, P<0.05). According to the receiver operating characteristic curve analysis, the predictive value of the combination of the three [FGF23, National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS)] for the occurrence of MACCE in AIS was higher than that of any of them (P<0.05), while the difference between the three was not statistically significant. The cumulative MACCE-free survival was found to be significantly higher in the group with low FGF23 levels than in the group with high FGF23 levels, as demonstrated by Kaplan-Meier analysis (P<0.05). The multifactorial Cox analysis revealed that the elevated baseline serum FGF23 level (HR: 3.731, 95% CI: 2.157-6.452) was a significant predictor of MACCE in AIS patients. CONCLUSIONS: Elevated baseline serum FGF23 levels were considered to be a valid predictor of MACCE in patients with AIS.

The authors have declared no competing interest.

This research was funded by the Medical Research Program of Jiangsu Provincial Health and Wellness Commission (grant no. Z2021042), the Development Fund of Affiliated Hospital of Xuzhou Medical University (grant no. XYFY202349), and the Jiangyin Young and Middle-aged Reserve Excellent Talents Program (grant no. JYROYT202309).

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study was obtained approval from the Ethics Committee of Jiangyin People's Hospital (Approval No. 2020008).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

The data supporting the findings of this study are availablefrom the corresponding author upon reasonable request.