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Clinical Trial
. 2019 Nov;25(11):894-901.
doi: 10.1016/j.cardfail.2019.07.003. Epub 2019 Jul 13.

Levels of Growth Differentiation Factor 15 and Early Mortality Risk Stratification in Cardiogenic Shock

Mari Hongisto  1 , Anu Kataja  1 , Tuukka Tarvasmäki  2 , Anu Holopainen  3 , Tuija Javanainen  2 , Raija Jurkko  2 , Toni Jäntti  2 , Antoine Kimmoun  4 , Bruno Levy  5 , Alexandre Mebazaa  6 , Kari Pulkki  7 , Alessandro Sionis  8 , Heli Tolppanen  2 , Kai C Wollert  9 , Veli-Pekka Harjola  1 , Johan Lassus  10 ; CardShock investigators
Affiliations
Clinical Trial

Levels of Growth Differentiation Factor 15 and Early Mortality Risk Stratification in Cardiogenic Shock

Mari Hongisto et al. J Card Fail. 2019 Nov.

Abstract

Background: The aim of this study was to assess the levels, kinetics, and prognostic value of growth differentiation factor 15 (GDF-15) in cardiogenic shock (CS).

Methods and results: Levels of GDF-15 were determined in serial plasma samples (0-120 h) from 177 CS patients in the CardShock study. Kinetics of GDF-15, its association with 90-day mortality, and incremental value for risk stratification were assessed. The median GDF-150h level was 9647 ng/L (IQR 4500-19,270 ng/L) and levels above median were significantly associated with acidosis, hyperlactatemia, renal dysfunction, and higher 90-day mortality (56% vs 28%, P < .001). Serial sampling showed that non-survivors had significantly higher GDF-15 levels at all time points (P < .001 for all). Furthermore, non-survivors displayed increasing and survivors declining GDF-15 levels during the first days in CS. Higher levels of GDF-15 were independently associated with mortality. A GDF-1512h cutoff >7000 ng/L was identified as a strong predictor of death (OR 5.0; 95% CI 1.9-3.8, P = .002). Adding GDF-1512h >7000 ng/L to the CardShock risk score improved discrimination and risk stratification for 90-day mortality.

Conclusions: GDF-15 levels are highly elevated in CS and associated with markers of systemic hypoperfusion and end-organ dysfunction. GDF-15 helps to discriminate survivors from non-survivors very early in CS.

Keywords: Cardiogenic shock; biomarkers; growth differentiation factor 15 (GDF-15); prognosis.

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