title: Growth differentiation factor-15 and prognosis in acute respiratory distress syndrome: a retrospective cohort study.
abstract: BACKGROUND
  We sought to determine whether higher levels of the novel biomarker growth differentiation factor-15 (GDF-15) are associated with poor outcomes and the presence of pulmonary vascular dysfunction (PVD) in patients with acute respiratory distress syndrome (ARDS).
  
  
  METHODS
  We conducted a retrospective cohort study in patients enrolled in the Acute Respiratory Distress Syndrome Network Fluid and Catheter Treatment (FACT) Trial. Patients enrolled in the FACT Trial who received a pulmonary artery catheter (PAC), had plasma available from the same study day and sufficient hemodynamic data to determine the presence of PVD were included. Logistic regression was used to determine the association between GDF-15 level and 60-day mortality.
  
  
  RESULTS
  Of the 513 patients enrolled in the FACT Trial assigned to receive a PAC, 400 were included in this analysis. Mortality at 60 days was significantly higher in patients whose GDF-15 levels were in the third (28%) or fourth (49%) quartile when compared to patients with GDF-15 levels in the first quartile (12%) (P <0.001). Adjusting for severity of illness measured by APACHE III score, the odds of death for patients with GDF-15 levels in the fourth quartile when compared to the first quartile was 4.26 (95% CI 2.18, 10.92, P <0.001). When added to APACHE III alone for prediction of 60-day mortality, GDF-15 levels increased the area under the receiver operating characteristic curve from 0.72 to 0.77. At an optimal cutoff of 8,103 pg/mL, the sensitivity and specificity of GDF-15 for predicting 60-day mortality were 62% (95% CI 53%, 71%) and 76% (95% CI 71%, 81%), respectively. Levels of GDF-15 were not useful in identifying the presence of PVD, as defined by hemodynamic measurements obtained by a PAC.
  
  
  CONCLUSIONS
  In patients with ARDS, higher levels of GDF-15 are significantly associated with poor outcome but not PVD.
authors.forename: Brendan J
authors.initials: BJ
authors.lastname: Clark
authors.forename: Todd M
authors.initials: TM
authors.lastname: Bull
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Benson
authors.forename: Amanda R
authors.initials: AR
authors.lastname: Stream
authors.forename: Madison
authors.initials: M
authors.lastname: Macht
authors.forename: Jeanette
authors.initials: J
authors.lastname: Gaydos
authors.forename: Christina
authors.initials: C
authors.lastname: Meadows
authors.forename: Ellen L
authors.initials: EL
authors.lastname: Burnham
authors.forename: Marc
authors.initials: M
authors.lastname: Moss
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002407:Catheterization, Swan-Ganz; D005260:Female; D005440:Fluid Therapy; D055436:Growth Differentiation Factor 15 / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011651:Pulmonary Artery / Q000503:physiopathology; D012128:Respiratory Distress Syndrome / Q000097:blood* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D055436:Growth Differentiation Factor 15