Key result
Higher baseline GDF-15 levels were an independent predictor of poor neurologic outcome at 6 months after out-of-hospital cardiac arrest (OR 3.74).
Why the study?
GDF-15 has prognostic value in cardiovascular diseases, but its value as an early predictor of neurologic outcome after an out-of-hospital cardiac arrest had not been explored.
Does admission serum GDF-15 level predict poor neurologic outcome at 6 months in comatose patients after out-of-hospital cardiac arrest?
Cohort (n=62)
No
Does admission serum GDF-15 level predict poor neurologic outcome at 6 months in comatose patients after out-of-hospital cardiac arrest?
Odds Ratio: 3.74 (95% CI 1.32–10.6)
p-value: p=0.013
Elevated GDF-15 levels on admission independently predict poor neurologic outcome at 6 months in comatose survivors of out-of-hospital cardiac arrest and improve risk discrimination when added to clinical models.
May support GDF-15 for post-arrest risk stratification; leaves open clinical utility pending prospective validation.
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 et al. (2019) conducted a cohort in Out-of-hospital cardiac arrest (n=62). Baseline GDF-15 levels vs. Lower GDF-15 levels was evaluated on Poor neurological outcome at 6 months (CPC 3-5) (OR 3.74, 95% CI 1.32-10.60, p=0.013). Higher baseline GDF-15 levels were an independent predictor of poor neurologic outcome at 6 months after out-of-hospital cardiac arrest (OR 3.74).
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