Department of Epidemiology and Health Statistics, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China.
Department of Neurology, Affiliated Hospital of Hebei United University, Hebei, China.
Clin Chem. 2019 Apr;65(4):569-578. doi: 10.1373/clinchem.2018.297879. Epub 2019 Jan 24.
Growth differentiation factor 15 (GDF-15), a stress-responsive biomarker, is known to be independently associated with mortality and cardiovascular events in different disease settings, but data on the prognostic value of GDF-15 after stroke are limited.
Baseline serum GDF-15 was measured in 3066 acute ischemic stroke patients from the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS). The primary outcome was a composite of death and major disability within 3 months. Secondary outcomes included death, major disability, vascular events, and stroke recurrence. The associations between GDF-15 and clinical outcomes after stroke were assessed by multivariate logistic regression or Cox proportional hazards models.
At 3 months' follow-up, 676 (22.05%), 86 (2.80%), 81 (2.64%), and 51 (1.66%) patients had experienced major disability, death, vascular events, or stroke recurrence, respectively. After adjusting for age, sex, current smoking, alcohol consumption, and baseline National Institutes of Health Stroke Scale score, the odds ratio/hazard ratio (95% CI) of 1 SD higher of base-10 log-transformed GDF-15 was 1.26 (1.15-1.39) for primary outcome, 1.13 (1.02-1.25) for major disability, 1.79 (1.48-2.16) for death, and 1.26 (1.00-1.58) for vascular events. The addition of GDF-15 to established risk factors improved risk prediction of the composite outcome of death and major disability (-statistic, net reclassification index, and integrated discrimination improvement, all < 0.05).
High GDF-15 concentrations are independently associated with adverse clinical outcomes of acute ischemic stroke, suggesting that baseline serum GDF-15 could provide additional information to identify ischemic stroke patients at high risk of poor prognosis.
生长分化因子 15（GDF-15）是一种应激反应生物标志物，已知其与不同疾病环境下的死亡率和心血管事件独立相关，但有关中风后 GDF-15 的预后价值的数据有限。
3066 名急性缺血性中风患者（来自中国降压试验急性缺血性中风研究，CATIS）的基线血清 GDF-15 进行了测量。主要结局是 3 个月内死亡和主要残疾的复合结局。次要结局包括死亡、主要残疾、血管事件和中风复发。通过多变量逻辑回归或 Cox 比例风险模型评估 GDF-15 与中风后临床结局的关系。
在 3 个月的随访中，676（22.05%）、86（2.80%）、81（2.64%）和 51（1.66%）名患者分别经历了主要残疾、死亡、血管事件或中风复发。在调整年龄、性别、当前吸烟、饮酒和基线国立卫生研究院中风量表评分后，GDF-15 的对数转换后每增加 1 个标准差，主要结局的优势比/风险比（95%CI）为 1.26（1.15-1.39），主要残疾为 1.13（1.02-1.25），死亡为 1.79（1.48-2.16），血管事件为 1.26（1.00-1.58）。将 GDF-15 添加到既定风险因素中可改善死亡和主要残疾复合结局的风险预测（-统计量、净重新分类指数和综合区分改善，均<0.05）。
高 GDF-15 浓度与急性缺血性中风的不良临床结局独立相关，提示基线血清 GDF-15 可能为识别预后不良风险较高的缺血性中风患者提供额外信息。
