Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China.
Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
Nutr Metab Cardiovasc Dis. 2022 Mar;32(3):616-623. doi: 10.1016/j.numecd.2021.12.005. Epub 2021 Dec 8.
Researchers have not determined whether the association between growth differentiation factor-15 (GDF-15) levels and stroke outcomes is modified by the diabetes status. We aimed to evaluate the prognostic value of GDF-15 among patients with ischemic stroke stratified by diabetes.
A total of 3001 patients with ischemic stroke were selected from the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) and included in this study. The primary outcome was a composite outcome of death and vascular events at 3 months after acute ischemic stroke. An elevated GDF-15 level was significantly associated with the primary outcome in patients with diabetes but not in those without diabetes (p = 0.038). The multivariate-adjusted hazard ratio (95% confidence intervals) for the primary outcome was 3.33 (1.07-10.35) when 2 extreme tertiles were compared, and a linear association between GDF-15 levels and the primary outcome was observed in patients with diabetes (p for linearity = 0.046). The addition of serum GDF-15 to conventional risk factors improved the risk prediction for the primary outcome in patients with diabetes (net reclassification improvement: 31.98%, p = 0.043; integrated discrimination index: 0.85%, p = 0.034) but not in those without diabetes.
A modifying effect of the diabetes status on the association between serum GDF-15 levels and ischemic stroke prognosis was observed. Elevated serum GDF-15 levels were associated with the primary outcome within 3 months after ischemic stroke in patients with diabetes, suggesting that GDF-15 may be an important prognostic factor for ischemic stroke in patients with diabetes.
研究人员尚未确定生长分化因子-15（GDF-15）水平与中风结局之间的关联是否受糖尿病状态的影响。我们旨在评估 GDF-15 在按糖尿病分层的缺血性中风患者中的预后价值。
从中国急性缺血性中风抗高血压试验（CATIS）中选择了 3001 例缺血性中风患者，并将其纳入本研究。主要结局是急性缺血性中风后 3 个月时死亡和血管事件的复合结局。在患有糖尿病的患者中，升高的 GDF-15 水平与主要结局显著相关，但在没有糖尿病的患者中则没有（p=0.038）。与 2 个极端三分位相比，主要结局的多变量调整后的危险比（95%置信区间）为 3.33（1.07-10.35），并且在患有糖尿病的患者中观察到 GDF-15 水平与主要结局之间存在线性关联（p 线性=0.046）。将血清 GDF-15 加入常规危险因素可改善糖尿病患者的主要结局风险预测（净重新分类改善：31.98%，p=0.043；综合判别指数：0.85%，p=0.034），但对无糖尿病患者则不然。
观察到糖尿病状态对血清 GDF-15 水平与缺血性中风预后之间的关联具有修饰作用。在患有糖尿病的患者中，血清 GDF-15 水平升高与缺血性中风后 3 个月内的主要结局相关，这表明 GDF-15 可能是糖尿病患者缺血性中风的重要预后因素。
