Usefulness of GDF-15 concentrations in plasma in prognosing serious adverse events and bleeding in acute pulmonary embolism: a prospective observational study

INTRODUCTION: Growth differentiation factor 15 (GDF‑15), a cytokine induced in the myocardium by pressure overload and ischemia, has a well‑established prognostic role for diseases of the left ventricle. Plasma GDF‑15 concentrations were shown to predict bleeding events in patients with atrial fibrillation on anticoagulation. OBJECTIVES: To investigate the prognostic value of GDF‑15 in acute pulmonary embolism (PE). PATIENTS AND METHODS: This was a prospective observational study of 77 patients hospitalized for PE. The median length of hospital stay and follow-up was 9 days. Plasma GDF‑15 levels were measured using an automated sandwich electrochemiluminescence immunoassay. The outcome measures were: 1) in‑hospital serious adverse events (SAE; death, cardiopulmonary resuscitation, need for urgent reperfusion therapy, catecholamine administration), and 2) major bleeding or nonmajor clinically relevant bleeding. RESULTS: There were 12 SAE and 5 bleeding events. The median (interquartile range) GDF‑15 concentration at admission was 2354 ng/l (1151-4750 ng/l). GDF‑15 concentrations increased according to risk subgroup. Patients with serious adverse events or bleeding events had higher baseline concentrations of GDF‑15 (median [interquartile range], 3460 ng/l [2 531-12 363 ng/l] vs 2034 ng/l [1121-4449 ng/l]; P = 0.01). The area under the curve for GDF‑15, high‑sensitivity cardiac troponin T, and N‑terminal pro-brain natriuretic peptide concentrations for predicting SAE was similar, the area under the curve of GDF‑15 levels for predicting bleeding was 0.783 (95% CI, 0.62-0.946; P = 0.001) and 0.71 (95% CI, 0.567-0.853; P = 0.004) for predicting any adverse event. In the multivariable analysis, GDF‑15 greater than 1680 ng/l emerged as an independent predictor of adverse outcomes (odds ratio, 8.9; P = 0.047). CONCLUSIONS: Plasma GDF‑15 concentrations may be a promising biomarker for predicting hemodynamic destabilization and bleeding complications in PE.