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. 2022 Nov;13(6):745-751.
doi: 10.1177/21501351221118080.

Growth Differentiation Factor 15: A Novel Growth Biomarker for Children With Congenital Heart Disease

Dane C Paneitz  1 , Alice Zhou  2 , Lisa Yanek  3 , Srujana Golla  4 , Sravani Avula  5 , Prince J Kannankeril  6 , Allen D Everett  7 , Bret A Mettler  4 , Danielle Gottlieb Sen  4
Affiliations

Growth Differentiation Factor 15: A Novel Growth Biomarker for Children With Congenital Heart Disease

Dane C Paneitz et al. World J Pediatr Congenit Heart Surg. 2022 Nov.

Abstract

Background: Failure to thrive (FTT), defined as weight or height less than the lowest 2.5 percentile for age, is prevalent in up to 66% of children with congenital heart disease (CHD). Risk stratification methods to identify those who would benefit from early intervention are currently lacking. We aimed to identify a novel growth biomarker to aid clinical decision-making in children with CHD.

Methods: This is a cross-sectional study of patients 2 months to 10 years of age with any CHD undergoing cardiac surgery. Preoperative weight-for-age Z scores (WAZ) and height-for-age Z scores (HAZ) were calculated and assessed for association with preoperative plasma biomarkers: growth differentiation factor 15 (GDF-15), fibroblast growth factor 21, leptin, prealbumin, and C-reactive protein (CRP).

Results: Of the 238 patients included, approximately 70% of patients had WAZ/HAZ < 0 and 34% had FTT. There was a moderate correlation between GDF-15 and WAZ/HAZ. When stratified by age, the correlation of GDF-15 to WAZ and HAZ was strongest in children under 2 years of age and persisted in the setting of inflammation (CRP > 0.5 mg/dL). Diagnoses commonly associated with congestive heart failure had high proportions of FTT and median GDF-15 levels. Prealbumin was not correlated with WAZ or HAZ.

Conclusions: GDF-15 represents an important growth biomarker in children with CHD, especially those under 2 years of age who have diagnoses commonly associated with CHF. Our data do not support prealbumin as a long-term growth biomarker.

Keywords: cytokines; metabolism; nutrition.

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Conflict of interest statement

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Correlation plots with line of best fit for log-transformed GDF-15 and WAZ/HAZ. GDF-15, growth differentiation factor 15; HAZ, height-for-age Z score; WAZ, weight-for-age Z score.
Figure 2.
Figure 2.
ROC curve for GDF-15 and FTT. FTT, failure to thrive; GDF-15, growth differentiation factor 15; ROC, receiver operating characteristic.
See this image and copyright information in PMC

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