GDF-15 and mortality: prognostic value in acute heart failure with reduced ejection fraction
L De Miguel, M Cortes Garcia, O Lorenzo Gonzalez, J Lumpuy-Castillo, J A 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
Background/Introduction
Heart failure with reduced ejection fraction (HFrEF) remains associated with substantial morbidity and mortality. Novel biomarkers have generated increasing interest, although their prognostic relevance is not fully established. This study assessed the prognostic value of growth differentiation factor-15 (GDF-15) with respect to mortality in patients admitted with acute HFrEF.
Purpose
To determine the association between admission GDF-15 concentrations and all-cause mortality in acute HFrEF.
Methods
We conducted a prospective, single-centre study including 104 patients with acute HFrEF. Serum and plasma samples were obtained at admission following informed consent. Several biomarkers were analysed, including GDF-15, a cytokine released by macrophages and cardiomyocytes in response to inflammation and oxidative stress. Univariable Cox regression was used to evaluate associations with all-cause mortality. Discriminative performance was assessed using receiver operating characteristic (ROC) curves, from which predictive cut-off values were derived.
Results
Of the 104 patients included (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, 20 deaths were recorded. GDF-15 was significantly associated with mortality (HR 1.30, 95% CI 1.16–1.45) with an AUC of 0.75, higher than that of NT-proBNP (0.66). A cut-off of 5,924 ng/ml yielded sensitivity 40%, specificity 95.2%, negative predictive value 87.0%, and positive predictive value 66.7%. ROC curves for NT-proBNP and GDF-15 are shown in the figure.
Conclusion
GDF-15 demonstrated meaningful prognostic value for all-cause mortality in acute HFrEF and outperformed NT-proBNP in this cohort. Larger studies are required to confirm these findings and to further define the role of GDF-15 across patient subgroups.Table 1.Baseline characteristicsFor image description, please refer to the figure legend and surrounding text.Figure1. Predictive capacity for mortalityFor image description, please refer to the figure legend and surrounding text.