Growth differentiation factor 15 and early prognosis after out-of-hospital cardiac arrest

Ferran Rueda, Germán Cediel, Cosme García-García, Júlia Aranyó, Marta González-Lopera, M. Cruz Aranda Nevado, Judith Serra Gregori, Teresa Oliveras, Carlos Labata, Marc Ferrer, Nabil El Ouaddi, Antoni Bayés-Genís

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Abstract

© 2019, The Author(s). 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.
Original languageEnglish
Article number119
JournalAnnals of Intensive Care
Volume9
DOIs
Publication statusPublished - 1 Dec 2019

Keywords

  • Biomarkers
  • Growth differentiation factor 15
  • Neurologic outcome
  • Out-of-hospital cardiac arrest
  • Prognostication

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    Rueda, F., Cediel, G., García-García, C., Aranyó, J., González-Lopera, M., Aranda Nevado, M. C., Serra Gregori, J., Oliveras, T., Labata, C., Ferrer, M., El Ouaddi, N., & Bayés-Genís, A. (2019). Growth differentiation factor 15 and early prognosis after out-of-hospital cardiac arrest. Annals of Intensive Care, 9, [119]. https://doi.org/10.1186/s13613-019-0593-9