Zhang Song, Hao Panpan, Li Jiaxin, Zhang Qi, Yin Xiaoying, Wang Jiali, Chen Yuguo
Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China.
Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, China.
Front Cardiovasc Med. 2023 Feb 10;10:1054187. doi: 10.3389/fcvm.2023.1054187. eCollection 2023.
The predictive value of growth differentiation factor-15 (GDF-15) for individual cardiovascular outcomes remained controversial in patients with coronary artery disease (CAD). We aimed to investigate the effects of GDF-15 on all-cause death, cardiovascular death, MI and stroke in CAD patients.
We searched PubMed, EMBASE, Cochrane library and Web of Science till 30 December, 2020. Hazard ratios (HRs) were combined with fixed or random effect meta-analyses. Subgroup analyses were performed in different disease types. Sensitivity analyses were used to evaluate the stability of the results. Publication bias was tested using funnel plots.
A total of 10 studies with 49,443 patients were included in this meta-analysis. Patients with the highest GDF-15 concentrations had significantly increased risk of all-cause death (HR 2.24; 95% CI: 1.95-2.57), cardiovascular death (HR 2.00; 95% CI: 1.66-2.42), MI (HR 1.42; 95% CI: 1.21-1.66) after adjusting clinical characteristics and prognostic biomarkers (hs-TnT, cystatin C, hs-CRP, and NT-proBNP) but except for stroke (HR 1.43; 95% CI: 1.01-2.03, = 0.05). For the outcome of all-cause death and cardiovascular death, subgroup analyses revealed consistent results. Sensitivity analyses showed that the results were stable. Funnel plots showed that there was no publication bias.
In CAD patients with elevated GDF-15 levels on admission, there were independently significant risks for all-cause death and cardiovascular death. The highest concentrations of GDF-15 had a lower predictive effect on MI than all-cause death and cardiovascular death. The association of GDF-15 with the outcome of stroke needs to be further studied.
在冠状动脉疾病（CAD）患者中，生长分化因子-15（GDF-15）对个体心血管结局的预测价值仍存在争议。我们旨在研究GDF-15对CAD患者全因死亡、心血管死亡、心肌梗死（MI）和中风的影响。
我们检索了截至2020年12月30日的PubMed、EMBASE、Cochrane图书馆和科学引文索引数据库。采用固定效应或随机效应荟萃分析合并风险比（HRs）。对不同疾病类型进行亚组分析。采用敏感性分析评估结果的稳定性。使用漏斗图检验发表偏倚。
本荟萃分析共纳入10项研究，涉及49443例患者。在校正临床特征和预后生物标志物（高敏肌钙蛋白T、胱抑素C、高敏C反应蛋白和N末端脑钠肽前体）后，GDF-15浓度最高的患者全因死亡风险显著增加（HR 2.24；95%置信区间：1.95-2.57）、心血管死亡风险显著增加（HR 2.00；95%置信区间：1.66-2.42）、心肌梗死风险显著增加（HR 1.42；95%置信区间：1.21-1.66），但中风风险除外（HR 1.43；95%置信区间：1.01-2.03，P = 0.05）。对于全因死亡和心血管死亡结局，亚组分析显示结果一致。敏感性分析表明结果稳定。漏斗图显示不存在发表偏倚。
在入院时GDF-15水平升高的CAD患者中，存在全因死亡和心血管死亡的独立显著风险。GDF-15的最高浓度对心肌梗死的预测作用低于全因死亡和心血管死亡。GDF-15与中风结局的关联需要进一步研究。
