Growth differentiation factor-15 for prognostic assessment of patients with acute pulmonary embolism.
BACKGROUND
Growth differentiation factor (GDF)-15 is a cytokine induced in the heart after ischemia or pressure overload. Circulating levels of GDF-15 provide independent prognostic information in patients with acute coronary syndromes or heart failure.


OBJECTIVE
We investigated the prognostic value of GDF-15 in acute pulmonary embolism.


METHODS
In a prospective cohort study, plasma levels of GDF-15 were determined by immunoradiometric assay in 123 consecutive patients with confirmed acute pulmonary embolism.


RESULTS
GDF-15 concentrations on admission ranged from 553 to 47,274 ng/L; 101 patients (82%) had GDF-15 levels above the upper limit of normal (1,200 ng/L). Patients who experienced pulmonary embolism-related complications during the first 30 days had higher baseline levels of GDF-15 (median, 6,039 [25th to 75th percentiles, 2,778 to 19,772] ng/L) compared with those with an uncomplicated course (median, 2,036 [25th to 75th percentiles, 1,279 to 3,176] ng/L; P < 0.001). By multivariable logistic regression analysis, which included clinical characteristics, cardiac biomarkers (troponin T and NT-proBNP [N-terminal propeptide of B-type natriuretic peptide]), and echocardiographic findings, GDF-15 emerged as an independent predictor of a complicated 30-day outcome (P = 0.033). The c-statistic for GDF-15 was 0.84 (95% confidence interval, 0.76-0.90), as compared with 0.72 for cardiac troponin T, and 0.65 for NT-proBNP. The ability of troponin T, NT-proBNP, and echocardiographic findings of right ventricular dysfunction to predict the risk of a complicated 30-day outcome was enhanced by GDF-15. Furthermore, multivariable Cox regression identified baseline levels of GDF-15 as an independent predictor of long-term mortality (P < 0.001).


CONCLUSIONS
GDF-15 is a promising new biomarker for risk stratification of pulmonary embolism.
Lankeit
Mareike
M
Department of Cardiology and Pulmonology, University of Goettingen, Goettingen, Germany.
Kempf
Tibor
T
Dellas
Claudia
C
Cuny
Mayumi
M
Tapken
Heike
H
Peter
Timo
T
Olschewski
Manfred
M
Konstantinides
Stavros
S
Wollert
Kai C
KC
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D015415:Biomarkers / Q000097:blood*; D016207:Cytokines / Q000097:blood*; D004452:Echocardiography; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D055436:Growth Differentiation Factor 15; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011655:Pulmonary Embolism / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D011863:Radioimmunoassay; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D020107:Troponin T / Q000097:blood
D015415:Biomarkers; D016207:Cytokines; C526140:GDF15 protein, human; D055436:Growth Differentiation Factor 15; D020107:Troponin T