Utility of preoperative growth differentiation factor-15 as a prognostic marker for ICU stay in patients undergoing coronary artery bypass grafting (CABG)

Prolonged intensive care unit (ICU) stay following coronary artery bypass grafting (CABG) is associated with increased morbidity, higher healthcare costs, and greater resource utilization. Elevated preoperative growth differentiation factor-15 (GDF-15) levels in CABG patients were associated with greater susceptibility to adverse outcomes, supporting its utility as a prognostic marker for the duration of ICU stay and adverse postoperative course. To evaluate the utility of preoperative GDF-15 levels in predicting prolonged ICU stay in CABG patients. This study was a retrospective analysis of prospectively collected data involving 85 patients who underwent off-pump CABG. Participants were stratified into group A (ICU stay ≤ 4 days, n = 31) and group B (ICU stay > 4 days, n = 54). Preoperative GDF-15 was quantified using a sandwich enzyme-linked immunosorbent assay (ELISA), and Spearman correlation, multivariable logistic regression, and receiver operating characteristic (ROC) analyses were performed. Preoperative GDF-15 was markedly elevated in group B compared to group A (720 vs. 220 ng/L; p < 0.001) and demonstrated a strong positive correlation with ICU stay (ρ = 0.691; p < 0.001) and an inverse correlation with ejection fraction (EF) (ρ = − 0.487; p < 0.001). ROC analysis showed excellent discriminatory ability (area under the curve (AUC) = 0.992; cutoff 400.50 ng/L; sensitivity 94%; specificity 98%; p < 0.001). Multivariable logistic regression demonstrated an independent association between GDF-15 and prolonged ICU stay (odds ratio (OR) = 1.017; 95% confidence interval (CI) 1.007–1.027; p < 0.001) after adjusting for blood pressure, EF, age, total cholesterol, and simplified acute physiology score II (SAPS II). Preoperative GDF-15 is significantly associated with prolonged ICU stay in patients undergoing CABG and demonstrates potential predictive utility, particularly in the Indian population where such data are limited. However, these findings remain exploratory and require validation in multicenter cohorts before routine clinical application. Preoperative GDF-15 assessment may aid in identifying high-risk patients, optimizing resource allocation, and facilitating preoperative counseling, particularly in high-volume tertiary care cardiac centers in resource-limited settings.