GDF-15 and heart failure readmissions: prognostic value in acute heart failure with reduced ejection fraction
L De Miguel, M Cortes Garcia, O Lorenzo Gonzalez, J Lumpuy-Castillo, A J Bollas Becerra, C S Garcia Talavera, M B Arroyo Rivera, J M Romero Otero, J A Esteban Chapel, I Mahillo Fernandez, M Taibo Urquia, A M Pello Lazaro, M L Gonzalez Casaus, J Tunon FernandezAbstract
Introduction
Several biomarkers are emerging in heart failure (HF), although their prognostic value remains incompletely defined. Growth differentiation factor-15 (GDF-15) has attracted interest as a stress-responsive cytokine linked to inflammation and oxidative stress. This study evaluated the prognostic role of GDF-15 regarding the risk of HF rehospitalisation in patients admitted with acute heart failure with reduced ejection fraction (HFrEF).
Purpose
To assess the association between admission GDF-15 concentrations and HF readmission in acute HFrEF.
Methods
We conducted a prospective, single-centre study including 104 patients with acute HFrEF. Serum and plasma samples were collected at admission after informed consent. Multiple biomarkers were analysed, including GDF-15. Univariable Cox regression was performed to evaluate associations with HF rehospitalisation. Discriminative capacity was assessed using receiver operating characteristic (ROC) curves, from which predictive cut-off values were derived.
Results
Among the 104 included patients (78% male; mean age 66.7 years), the mean left ventricular ejection fraction was 21%. At the end of follow-up, 90% were receiving beta-blockers, 87% ACE inhibitors/angiotensin receptor blockers/angiotensin receptor–neprilysin inhibitors, 74% mineralocorticoid receptor antagonists, and 72% sodium–glucose co-transporter-2 inhibitors (Table 1). After a median follow-up of 23.5 months, 21 HF readmissions were recorded. GDF-15 was significantly associated with rehospitalisation for HF (HR 1.22, 95% CI 1.07–1.38) with an AUC of 0.62, higher than that of NT-proBNP for this outcome (AUC 0.44). Using 10.9 ng/ml as the cut-off, sensitivity was 14%, specificity 98.8%, negative predictive value 75%, and positive predictive value 82%, with a prevalence of 19.2%. ROC curves for NT-proBNP and GDF-15 are presented in the figure 1.
Conclusion
GDF-15 demonstrated acceptable prognostic value for HF rehospitalisation in patients with acute HFrEF and outperformed NT-proBNP for this endpoint. Larger studies are warranted to validate these findings and to clarify the role of GDF-15 across different patient subgroups.Table 1.Baseline characteristicsFor image description, please refer to the figure legend and surrounding text.Figure1Predictive capacity for admissionFor image description, please refer to the figure legend and surrounding text.