Dynamics of growth differentiation factor 15 in acute heart failure

Abstract

Aims Risk stratification in acute heart failure (HF) patients can help to decide therapies and time for discharge. The potential of growth differentiation factor 15 (GDF-15) in HF has been previously shown. We aimed to study the importance of GDF-15level variations in acute HF patients. Methods and resultsWe retrospectively evaluated a cohort of patients hospitalized due to acute HF. GDF-15 was measured both at admission and on the discharge day. Patients were followed-up during a 3 year period. The endpoint under analysis was all-cause mortality. GDF-15 variation is equal to [(admission GDF-15 À discharge GDF-15)∕admission GDF-15] × 100. Variation was categorized in levels of increase or decrease of GDF-15. Patients were cross-classified according to admission and discharge GDF-15 cut-off points. A Cox regression analysis was used to assess the prognostic impact of GDF-15 variation and the impact of both admission and discharge GDF-15 according to the cross-classification. We studied a group of 249 patients with high co-morbidity burden. Eighty-one patients died at 1 year and 147 within 3 years. There was a modest decrease in GDF-15 during hospitalization from a median value of 4087 to 3671 ng/mL (P = 0.02). No association existed between GDF-15 variation and mortality. In multivariate analysis, patients with admission GDF-15 ≥ 3500 ng/mL and discharge GDF-15 ≥ 3000 ng/mL had a significantly higher 1 year death risk when compared with the remaining-hazard ratio = 2.59 (95% confidence interval: 1.41-4.76)-and a 3 year 1.76 (95% confidence interval: 1.08-2.87) higher death risk compared with those with both values below the cut-off. Conclusions Growth differentiation factor 15 decreased during an acute HF hospitalization, but its variation had no prognostic implications. The knowledge of both admission and discharge GDF-15 added meaningful information to patients' risk stratification.

Inflammation and remodeling pathways and risk of cardiovascular events in patients with ischemic heart failure and reduced ejection fraction

“…In the BIOSTAT cohort, GDF-15 was one of the main biomarkers differentiating inpatient and outpatient settings, with GDF-15 being higher in inpatients 4 . However, these 2 previous cohorts reported contrasting associations: Lourenço et al reported that, in multivariable analysis, patients with either elevated admission or discharge GDF-15 had a significant twofold increase in 1-year death risk 21 . In contrast, in the BIOSTAT cohort, higher GDF-15 levels were associated with lower rates of HF hospitalization in the inpatient subgroup (HR = 0.80 (0.67, 0.95), p = 0.01) 4 , whereas GDF-15 was not retained as a significant predictor in the outpatient subgroup.…”

“…GDF-15 is associated with death and/or HFH in hospitalized 4 , 21 patients with HF. This biomarker has also been shown to decrease during hospital stay in concomitance with improvement of signs and symptoms 21 , which suggests that it may be partially related to congestion.…”

“…GDF-15 is associated with death and/or HFH in hospitalized 4 , 21 patients with HF. This biomarker has also been shown to decrease during hospital stay in concomitance with improvement of signs and symptoms 21 , which suggests that it may be partially related to congestion. In the BIOSTAT cohort, GDF-15 was one of the main biomarkers differentiating inpatient and outpatient settings, with GDF-15 being higher in inpatients 4 .…”

Increased serum concentrations of growth differentiation factor-15 in children with acute rheumatic fever

“…5 The increased levels of growth differentiation factor-15 is reported to be associated with various cardiovascular diseases. [6][7][8][9]15,22 It may provide additional information and act as a predictor in chronic heart failure. 15 It was shown to be a prognostic factor independent of other biomarkers in heart failure with both preserved and reduced ejection fraction, but it is not discriminative or diagnostic for heart failure.…”

Obituary: Paulo Bettencourt 1965–2021

“…Natriuretic peptides are currently fully integrated in HF diagnosis and prognostic assessment in routine practice, and Paulo set the ground for the evidence generation. In the past few years, his passion for HF biomarkers extended to neutrophil gelatinase‐associated lipocalin (NGAL) and growth differentiation factor‐15 (GDF‐15), both for the study of the prognostic value of these biomarkers in HF and exploring how biomarkers could help in the understanding of the disease mechanisms and HF‐associated comorbidities and complications, such as worsening kidney function 5,6 . He recently was working on antigen carbohydrate 125 and how its changes could be used to better understand acute HF.…”