Growth differentiation factor 15 and early prognosis after out-of-hospital cardiac arrest
Posted on 2019-10-18 - 09:29
Abstract Background Growth differentiation factor 15 (GDF-15) is an inflammatory cytokine released in response to tissue injury. It has prognostic value in cardiovascular diseases and other acute and chronic conditions. Here, we explored the value of GDF-15 as an early predictor of neurologic outcome after an out-of-hospital cardiac arrest (OHCA). Methods Prospective registry study of patients in coma after an OHCA, admitted in the intensive cardiac care unit from a single university center. Serum levels of GDF-15 were measured on admission. Neurologic status was evaluated according to the cerebral performance category (CPC) scale. The relationship between GDF-15 levels and poor neurologic outcome at 6 months was analyzed. Results Among 62 patients included, 32 (51.6%) presented poor outcome (CPC 3–5). Patients with CPC 3–5 exhibited significantly higher GDF-15 levels (median, 17.1 [IQR, 11.1–20.4] ng/mL) compared to those with CPC 1–2 (7.6 [IQR, 4.1–13.1] ng/mL; p = 0.004). Multivariable logistic regression analyses showed that age (OR, 1.09; 95% CI 1.01–1.17; p = 0.020), home setting arrest (OR, 8.07; 95% CI 1.61–40.42; p = 0.011), no bystander cardiopulmonary resuscitation (OR, 7.91; 95% CI 1.84–34.01; p = 0.005), and GDF-15 levels (OR, 3.74; 95% CI 1.32–10.60; p = 0.013) were independent predictors of poor outcome. The addition of GDF-15 in a dichotomous manner (≥ 10.8 vs. < 10.8 ng/mL) to the resulting clinical model improved discrimination; it increased the area under the curve from 0.867 to 0.917, and the associated continuous net reclassification improvement was 0.90 (95% CI 0.48–1.44), which allowed reclassification of 37.1% of patients. Conclusions After an OHCA, increased GDF-15 levels were an independent, early predictor of poor neurologic outcome. Furthermore, when added to the most common clinical factors, GDF-15 improved discrimination and allowed patient reclassification.
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Rueda, Ferran; Cediel, Germán; García-García, Cosme; Aranyó, Júlia; González-Lopera, Marta; Aranda Nevado, M. Cruz; et al. (2019). Growth differentiation factor 15 and early prognosis after out-of-hospital cardiac arrest. figshare. Collection. https://doi.org/10.6084/m9.figshare.c.4703792.v1
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AUTHORS (12)
FR
Ferran Rueda
GC
Germán Cediel
CG
Cosme García-García
JA
Júlia Aranyó
MG
Marta González-Lopera
MA
M. Cruz Aranda Nevado
JS
Judith Serra Gregori
TO
Teresa Oliveras
CL
Carlos Labata
MF
Marc Ferrer
NE
Nabil El Ouaddi
AB
Antoni Bayés-Genís