Abstract
Background: Previous studies had reported increased circulating concentrations of growth differentiation factor-15 (GDF-15) in chronic heart failure (CHF), suggesting the potential prognostic significance of GDF-15 in this setting. To verify the relationship between the circulating GDF-15 levels and prognosis of CHF patients, we conducted an updated evidence-based meta-analysis.Methods: A comprehensive literature retrieval of PubMed, EMBASE, and Cochrane library was performed to collect the qualified studies that analyzed the prognostic value of GDF-15 in CHF from the inception of these online databases to September 25, 2021. The hazard ratio (HR) calculated for logGDF-15 of all-cause death and the related 95% confidence interval (CI) in multivariate analysis were used to measure the effect size. Additionally, subgroup analyses stratified by characteristics of the study participants were conducted for incremental evidence of GDF-15 in CHF with different clinical status.Results: A total of ten eligible studies involving 6,244 CHF patients were finally taken into the quantitative analysis. Results in the random-effects model indicated that there was an increased risk of 6% in all-cause mortality with a per 1LnU increase in baseline GDF-15 concentration (HR: 1.06, 95% CI: 1.03–1.10, P < 0.001). In stratified analyses, the association of GDF-15 with risk of all-cause mortality was found among chronic ischemic HF patients (HR:1.75, 95%CI: 1.24–2.48, P = 0.002), while the association was not found among chronic nonischemic HF patients (HR:1.01, 95%CI: 1.00–1.02, P = 0.219).Conclusion: The elevated GDF-15 is associated with an increased risk of all-cause mortality in CHF, especially, among CHF patients with ischemic etiology. The circulating GDF-15 might be a prognostic indicator in CHF patients.Registration Number: https://www.crd.york.ac.uk/PROSPERO; CRD42020210796.
Highlights
Heart failure (HF), the terminal stage of multiple cardiovascular diseases (CVD), is a complex clinical syndrome with high morbidity and mortality (1)
The association of growth differentiation factor-15 (GDF-15) with risk of all-cause mortality was found among chronic ischemic HF patients (HR:1.75, 95%confidence interval (CI): 1.24–2.48, P = 0.002), while the association was not found among chronic nonischemic HF patients (HR:1.01, 95%CI: 1.00–1.02, P = 0.219)
The elevated GDF-15 is associated with an increased risk of all-cause mortality in chronic heart failure (CHF), especially, among CHF patients with ischemic etiology
Summary
Heart failure (HF), the terminal stage of multiple cardiovascular diseases (CVD), is a complex clinical syndrome with high morbidity and mortality (1). In spite of guideline-directed management, the prognosis of chronic heart failure (CHF) remains poor and the mortality exceeds 50% in five years (2). B-type natriuretic peptide (BNP) and N-terminal pro B-type natriuretic peptide (NT-pro BNP) mainly synthesized by ventricular cardiomyocytes related with cardiac overload, have been established as two effective biomarkers for diagnosis and predicting prognosis of HF (2, 3). Previous studies had reported increased circulating concentrations of growth differentiation factor-15 (GDF-15) in chronic heart failure (CHF), suggesting the potential prognostic significance of GDF-15 in this setting. To verify the relationship between the circulating GDF-15 levels and prognosis of CHF patients, we conducted an updated evidence-based meta-analysis
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