Calen Christelle, Von Moos Seraina, Cippà Pietro, Mebazaa Alexandre, Arrigo Mattia
Division of General Internal Medicine, Hirslanden Zurich, Zurich, Switzerland.
Department of Nephrology, University Hospital Zurich, Zurich, Switzerland.
Int J Nephrol. 2023 Mar 23;2023:5163548. doi: 10.1155/2023/5163548. eCollection 2023.
Noninvasive identification of haemodialysis patients at high risk of cardiovascular events and death might improve their outcome. Growth differentiation factor 15 is a prognostic biomarker in multiple disease entities, including cardiovascular disease. The aim of this study was to assess the association between plasma GDF-15 and mortality in a cohort of haemodialysis patients.
Circulating GDF-15 was measured in 30 patients after a regular haemodialysis session, followed by a clinical follow-up for all-cause death. Measurements were performed using the Proseek Multiplex Cardiovascular disease panels (Olink Proteomics AB) and validated using the Elecsys GDF-15 electrochemiluminescence immunoassay on a Cobas E801 analyzer (Roche Diagnostics).
During a median of 38 months, 9 patients (30%) died. Seven deaths occurred in the group of patients with a circulating GDF-15 above the median and two in the group with lower GDF-15. Mortality was significantly higher in patients with circulating GDF-15 levels above the median, log-rank = 0.044. The performance of circulating GDF-15 to predict long-term mortality has an area under the ROC curve of 0.76, = 0.028. Prevalence of most relevant comorbidities and the Charlson comorbidity index were similar across the two groups. A high agreement with a correlation among both diagnostic methods was observed (Spearman's rho = 0.83, < 0.001).
Plasma GDF-15 displays promising prognostic properties for the prediction of long-term survival beyond clinical parameters in patients on maintenance haemodialysis.
对心血管事件和死亡高风险的血液透析患者进行无创识别可能会改善其预后。生长分化因子15是包括心血管疾病在内的多种疾病实体中的一种预后生物标志物。本研究的目的是评估一组血液透析患者血浆生长分化因子15（GDF-15）与死亡率之间的关联。
在30例患者进行常规血液透析后测量循环中的GDF-15，随后对全因死亡进行临床随访。使用Proseek多重心血管疾病检测板（Olink蛋白质组学公司）进行测量，并在Cobas E801分析仪（罗氏诊断公司）上使用Elecsys GDF-15电化学发光免疫分析法进行验证。
在中位38个月期间，9例患者（30%）死亡。循环GDF-15高于中位数的患者组中有7例死亡，GDF-15较低的患者组中有2例死亡。循环GDF-15水平高于中位数的患者死亡率显著更高，对数秩检验P = 0.044。循环GDF-15预测长期死亡率效能的ROC曲线下面积为0.76，P = 0.028。两组中最相关合并症的患病率和查尔森合并症指数相似。观察到两种诊断方法之间具有高度一致性且存在相关性（斯皮尔曼相关系数rho = 0.83，P < 0.001）。
对于维持性血液透析患者，血浆GDF-15在预测长期生存方面显示出优于临床参数的良好预后特性。
