Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Zip Code 10330, Thailand.
Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand.
BMC Cardiovasc Disord. 2024 Mar 12;24(1):151. doi: 10.1186/s12872-024-03802-5.
Acute heart failure (AHF) is a potentially life-threatening clinical syndrome, usually requiring hospital admission. Growth Differentiation Factor-15 (GDF-15) is a distant member of the transforming growth factor-β. The increased expression of GDF-15 has been observed during heart failure (HF) and is associated with worse outcomes. However, the relationship between GDF-15 and AHF is not well understood with limited evidence among Thai patients.
Investigate the correlation between biomarker levels (measured upon admission and discharge) and short- and long-term adverse outcomes, encompassing all-cause mortality and heart-failure (HF) rehospitalization (at 30, 90, and 180 days, as well as throughout the entire follow-up duration) in individuals experiencing acute HF.
This is a prospective single-center investigation involving patients admitted for AHF. Biomarkers, including GDF-15, high-sensitivity troponin T (hsTnT), and N-terminal pro-B-type natriuretic peptide (NT-proBNP), were assessed upon admission and discharge. Outcomes, including all-cause mortality and HF rehospitalization, were examined. Logarithmic transformations were applied to the biomarker variables for subsequent analysis. Univariate and multivariate analyses of cause-specific hazards were conducted using the Cox proportional hazards regression model, while subdistribution hazards were assessed using the Fine-Gray regression model to evaluate outcomes.
A total of 84 patients were enrolled (mean age of 69 years, 52% females). The GDF-15 level significantly decreased during admission (median at the time of admission 6,346 pg/mL, median at the time of discharge 5,711 pg/mL; p < 0.01). All-cause mortality at 30 days and 180 days were 6.0% and 16.7%, respectively. HF rehospitalization at 30 days and 180 days were 15.5% and 28.6%, respectively. Univariate analysis showed that total orthoedema congestion score (p = 0.02) and admission GDF-15 level (p = 0.01) were associated with 30-day all-cause mortality, whereas hsTnT or NT-proBNP levels did not show significant associations. However, higher levels of NT-proBNP upon admission were associated with all-cause mortality when considering the entire follow-up period (p < 0.01). Both univariate and multivariate analyses demonstrated that lower discharge GDF-15 levels and a greater reduction in GDF-15 levels from admission to discharge were associated with a lower risk of 30-day rehospitalization. Similarly, univariate analysis revealed that a greater reduction in NT-proBNP levels from admission to discharge was associated with lower 30-day rehospitalization rates. At 180 days, a greater reduction in GDF-15 levels remained associated with lower hazards and incidence of rehospitalization.
The significant decrease in Growth Differentiation Factor-15 (GDF-15) levels during hospitalization suggests its potential as a dynamic marker reflecting the course of AHF. Importantly, higher GDF-15 levels at admission were associated with an increased risk of 30-day all-cause mortality, highlighting its prognostic value in this patient population. Moreover, lower discharge GDF-15 levels, reductions in GDF-15 from admission to discharge, and decreases in NT-proBNP from admission to discharge were associated with a reduced risk of 30-day rehospitalization.
急性心力衰竭（AHF）是一种潜在的危及生命的临床综合征，通常需要住院治疗。生长分化因子 15（GDF-15）是转化生长因子-β的远亲。心力衰竭（HF）期间观察到 GDF-15 的表达增加，与更差的结局相关。然而，在泰国患者中，GDF-15 与 AHF 的关系尚未得到很好的理解，证据有限。
研究生物标志物水平（入院时和出院时测量）与短期和长期不良结局之间的相关性，包括所有原因死亡率和心力衰竭（HF）再入院（在 30、90 和 180 天，以及整个随访期间）在经历急性 HF 的个体中。
这是一项前瞻性单中心研究，涉及因 AHF 入院的患者。入院和出院时评估了包括 GDF-15、高敏肌钙蛋白 T（hsTnT）和 N 端 pro-B 型利钠肽（NT-proBNP）在内的生物标志物。检查了包括全因死亡率和 HF 再入院在内的结局。对生物标志物变量进行对数变换，以便后续分析。使用 Cox 比例风险回归模型进行单变量和多变量病因特异性风险分析，使用 Fine-Gray 回归模型评估亚分布风险，以评估结局。
共纳入 84 例患者（平均年龄 69 岁，52%为女性）。入院期间 GDF-15 水平显著下降（入院时中位数为 6346pg/mL，出院时中位数为 5711pg/mL；p<0.01）。30 天和 180 天的全因死亡率分别为 6.0%和 16.7%。30 天和 180 天的 HF 再入院率分别为 15.5%和 28.6%。单变量分析显示，总充血性水肿评分（p=0.02）和入院时 GDF-15 水平（p=0.01）与 30 天全因死亡率相关，而 hsTnT 或 NT-proBNP 水平无显著相关性。然而，考虑整个随访期时，入院时较高的 NT-proBNP 水平与全因死亡率相关（p<0.01）。单变量和多变量分析均表明，出院时 GDF-15 水平较低，从入院到出院 GDF-15 水平的降低幅度较大，与 30 天再入院风险降低相关。同样，单变量分析显示，从入院到出院 NT-proBNP 水平的降低与 30 天再入院率降低相关。在 180 天时，GDF-15 水平的较大降低仍然与较低的再入院风险和发生率相关。
住院期间 GDF-15 水平的显著下降表明其作为反映 AHF 病程的动态标志物的潜力。重要的是，入院时较高的 GDF-15 水平与 30 天全因死亡率增加相关，突出了其在该患者人群中的预后价值。此外，较低的出院 GDF-15 水平、入院到出院 GDF-15 水平的降低以及入院到出院 NT-proBNP 水平的降低与 30 天再入院风险降低相关。
