What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Acute coronary syndrome (n=8903). Intervention: High plasma GDF-15 levels vs. Low plasma GDF-15 levels. Primary outcome: Mortality (RR 6.08, 95% CI 4.79-7.71, p=<0.00001).

May 6, 2016Open Access

Growth differentiation factor–15 predicts the prognoses of patients with acute coronary syndrome: a meta-analysis

Q: What are the key findings of this study?

High plasma GDF-15 levels are associated with a significantly increased risk of mortality (RR 6.08) compared to low levels in patients with acute coronary syndrome.

Key Result

High plasma GDF-15 levels are associated with a significantly increased risk of mortality (RR 6.08) compared to low levels in patients with acute coronary syndrome.

Study Design

Type

Meta-Analysis (n=8,903)

Structured PICO

Do high plasma GDF-15 levels predict increased risk of mortality and recurrent MI in patients with acute coronary syndrome?

Population

8,903 patients with acute coronary syndrome from 8 studies, followed for 6 months to 6 years, to evaluate the prognostic value of GDF-15 levels.

Exposure

High plasma GDF-15 levels (e.g., >1800 ng/L)

Comparator

Low plasma GDF-15 levels (e.g., <1200 ng/L)

Outcome

Mortality and recurrent myocardial infarction (MI)hard clinical

High plasma GDF-15 levels are strongly associated with an increased risk of mortality and recurrent myocardial infarction in patients with acute coronary syndrome, suggesting its potential utility as a prognostic biomarker.

Main Result

Relative Risk: 6.08 (95% CI 4.79–7.71)

p-value: p=<0.00001

Limitations

Definitions of all-cause mortality and cardiovascular mortality were not confirmed in most studies
GDF-15 levels might be influenced by confounding factors such as age, male gender, current smoking, symptomatic heart failure, reduced kidney function, and diabetes mellitus
ACS patients were treated with different treatment strategies, which might alter GDF-15 levels
Blood samples were extracted at different times after ACS events
Follow-up durations differed across the included studies

Abstract

BACKGROUND: Recent studies have shown Growth differentiation factor-15 (GDF-15) that is a member of the transforming growth factor β (TGF-β) superfamily might be a potential predictive cytokine for the prognosis of Acute coronary syndrome (ACS). However, there are discrepancies in these studies. METHODS: Publication searches of the PubMed/Medline and EMBASE databases were performed without any time or ethnicity restrictions. The inclusion and exclusion criteria, when clear, were addressed. Random effects models were used for all analyses. Publication bias was tested using funnel plots and the Egger test. RESULTS: We identified eight eligible studies that provided mortality data. Five of these studies provided recurrent myocardial infarction (MI) data. The maximal duration of follow-up ranged from 6 months to 6 years. A significant association was found between the patients with the highest and lowest GDF-15 levels (overall analyses) in terms of mortality (p < 0.00001; RR = 6.08; 95 % CI = 4.79-7.71) and recurrent MI (p < 0.00001; RR = 1.76; 95 % CI = 1.49-2.07). We also found significant associations between the subgroup analyses stratified by ACS types, cutoff points and follow-up durations (p < 0.001). The combined hazard ratio was high for GDF-15 to ACS (HR = 1.656, 95 % CI = 1.467-1.871). CONCLUSION: High plasma GDF-15 levels are associated with an increased risk of mortality and recurrent MI in patients with ACS.

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