Growth differentiation factor-15 combined with N-terminal prohormone of brain natriuretic peptide increase 1-year prognosis prediction value for patients with acute heart failure

Abstract

Background:Clinical assessment and treatment guidance for heart failure depends on a variety of biomarkers. The objective of this study was to investigate the prognostic predictive value of growth differentiation factor-15 (GDF-15) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) in assessing hospitalized patients with acute heart failure (AHF).Methods:In total, 260 patients who were admitted for AHF in the First Affiliated Hospital of Nanjing Medical University were enrolled from April 2012 to May 2016. Medical history and blood samples were collected within 24 h after the admission. The primary endpoint was the all-cause mortality within 1 year. The patients were divided into survival group and death group based on the endpoint. With established mortality risk factors and serum GDF-15 level, receiver-operator characteristic (ROC) analyses were performed. Cox regression analyses were used to further analyze the combination values of NT-proBNP and GDF-15.Results:Baseline GDF-15 and NT-proBNP were significantly higher amongst deceased than those in survivors (P < 0.001). In ROC analyses, area under curve (AUC) for GDF-15 to predict 1-year mortality was 0.707 (95% confidence interval [CI]: 0.648–0.762, P < 0.001), and for NT-proBNP was 0.682 (95% CI: 0.622–0.738, P < 0.001). No statistically significant difference was found between the two markers (P = 0.650). Based on the optimal cut-offs (GDF-15: 4526.0 ng/L; NT-proBNP: 1978.0 ng/L), the combination of GDF-15 and NT-proBNP increased AUC for 1-year mortality prediction (AUC = 0.743, 95% CI: 0.685–0.795, P < 0.001).Conclusions:GDF-15, as a prognostic marker in patients with AHF, is not inferior to NT-proBNP. Combining the two markers could provide an early recognition of high-risk patients and improve the prediction values of AHF long-term prognosis.Clinical trial registration:ChiCTR-ONC-12001944, http://www.chictr.org.cn.

A Rising Star of the Multimarker Panel: Growth Differentiation Factor-15 Levels Are an Independent Predictor of Mortality in Acute Heart Failure Patients Admitted to an Emergency Clinical Hospital from Eastern Europe

“…Basically, even isolated increases of GDF-15 were an independent and superior predictor of mortality, compared to patients with only isolated increases of NT-proBNP (25% versus 10.5% mortality rate, p < 0.05). Moreover, an even higher fatality rate (40%) was recorded when both GDF-15 and NT-proBNP were elevated, a finding consistent with previous results showing significant increases in mortality estimates based on composite models [56][57][58][59].…”

Multimarker Analysis of Serially Measured GDF-15, NT-proBNP, ST2, GAL-3, cTnI, Creatinine, and Prognosis in Acute Heart Failure

“…8 Studies that have analyzed elevated GDF-15 specifically in patients with acute HF are limited in number. 10,[18][19][20] Unlike a single timepoint-based measurement, repeated measurements take into account the temporal evolution as a result of the dynamic natural disease progression. Our study underscores the usefulness of repeated measurements GDF-15, which provided a better risk discrimination than a single (baseline) measurement alone.…”

Dynamics of growth differentiation factor 15 in acute heart failure

“…More than half of the patients were admitted in New York Heart Association Class IV, and natriuretic peptide system was highly activated. Median (inter-quartile range) length of hospital stay was of 7 (5)(6)(7)(8)(9)(10)(11) days. Eighty-one patients died at 1 year of follow-up, and 147 patients died within 3 years.…”

“…Growth differentiation factor 15 (GDF‐15) is currently one of the most attractive biomarkers that provides strong prognostic information 9,10 . GDF‐15 is a member of the transforming growth factor‐β superfamily and was identified in a broad range of cells 11–14 .…”