Association of Baseline and Dynamic Changes in Growth Differentiation Factor-15 Changes with Longitudinal Myocardial Function in Sepsis

Septic cardiomyopathy is a common complication of sepsis that significantly contributes to hemodynamic instability and adverse clinical outcomes. Despite increasing understanding of its pathophysiology, there is still no specific biomarker that reliably reflects myocardial function during sepsis. Growth differentiation factor-15 (GDF-15) is a cytokine induced by cellular stress associated with inflammation, oxidative stress, and cardiovascular damage. However, the relationship between GDF-15 and echocardiographic markers of septic myocardial dysfunction remains poorly understood. The aim of this study was to examine the association of serum concentrations of GDF-15 and high-sensitivity troponin I (hs-TnI) with echocardiographic parameters of systolic and diastolic myocardial function in patients with sepsis. This prospective observational study included 50 patients with sepsis treated in the Intensive Care Unit of the Osijek Clinical Hospital Center between 2023 and 2025. GDF-15 and hs-TnI concentrations were measured at admission and during follow-up, while transthoracic echocardiography was performed at the same time points to assess myocardial function. Single concentrations of GDF-15 were not significantly associated with most conventional echocardiographic parameters, but showed a positive association with the E/A ratio. In multivariable analysis adjusted for illness severity (SOFA score), admission GDF-15 was independently associated with left ventricular longitudinal systolic function (MAPSE). Changes in GDF-15 during hospitalization were associated with echocardiographic measurements of longitudinal myocardial function obtained at admission and follow-up, including mitral annular plane systolic excursion (MAPSE), tricuspid annular plane systolic excursion (TAPSE), tissue Doppler systolic velocity (S′), and isovolumetric relaxation time (IVRT). In contrast, hs-TnI did not show a consistent association with echocardiographic parameters. These findings suggest that serial GDF-15 assessment may provide additional insight into myocardial functional changes during sepsis and complement the echocardiographic evaluation of septic cardiomyopathy.