GDF-15: a novel biomarker of heart failure predicts 30-day all-cause mortality and 30-day HF rehospitalization in patients with acute heart failure syndrome

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Ratchadapiseksomphotch Fund, Faculty of Medicine, Chulalongkorn University Background Growth Differentiation Factor-15 (GDF-15) is a distant member of the transforming growth factor-β (TGF-β) cytokine super family. The increased expression of GDF-15 has been observed during various cardiac diseases include heart failure (HF) and may associated with worse outcomes. However, the relationship is still not well understood, and evidences are not existed in Thai patients. Purpose To study association between biomarker (GDF-15, NT-proBNP and hs-Troponin T) at the time of admission and discharge in patient with AFHS and their association with 30-day all-cause mortality and 30-day heart failure rehospitalization Methods This is a prospective, single center study of patients admitted for acute HF syndrome regardless of ejection fraction between December 2018 to June 2019. GDF-15 were measured within 24 hours after admission and at the time of discharge. Patient characteristics, orthoedema congestion score, biomarkers, treatment and outcome including 30-day, all-cause mortality and rehospitalization were collected. Logistic regression analysis was used to evaluate the relationship between GDF-15 level and outcomes. Results Total of 103 patients were screened and 84 patients were enrolled (mean age of 69 ± 14 years, 52.4% females). Ischemic heart diseases were reported in 38.1% and 23.1% of patients had history of HF with reduced ejection fraction. The orthoedema congestion score at the time of admission and discharge were 2.29 ± 0.1 and 0.38 ± 0.8, respectively (score from 0 to 4, with lower scores are less congestion). The GDF-15 level was significantly decrease during admission (at the time of admission 9118 ± 6010 pg/mL, at time of discharge 7107 ± 4787 pg/mL, mean differences 1528 ± 4469; p = 0.006). The 30-day all-cause mortality was 5.95%. The 30-day rehospitalization occurred in 22 (26.1%) patients (13 HF rehospitalization and 9 non-HF rehospitalization). Univariate analysis showed that the admission GDF-15 level, but not troponin or NT-proBNP, was associated with 30-days all-cause mortality (p = 0.029) and multivariate analysis showed reduction in GDF-15 level from admission to discharge was associated with lower 30-days rehospitalization (p = 0.023). Conclusion In this single center study, the rate of mortality and rehospitalization is very high in patient discharge after acute HF hospitalization. the GDF-15 levels were elevated during acute HF and improving by the time of discharge. This novel biomarker may offer additional value in predicting the risk of outcomes in patient with acute HF.