Levels of Growth Differentiation Factor 15 and Early Mortality Risk Stratification in Cardiogenic Shock
Por:
Hongisto, M, Kataja, A, Tarvasmaki, T, Holopainen, A, Javanainen, T, Jurkko, R, Jantti, T, Kimmoun, A, Levy, B, Mebazaa, A, Pulkki, K, Sionis, A, Tolppanen, H, Wollert, KC, Harjola, VP, Lassus, J, Cardshock Investigators
Publicada:
1 nov 2019
Resumen:
Background: The aim of this study was to assess the levels, kinetics, and prognostic value of growth differentiation factor 15 (GDF-15) in cardiogenic shock (CS).
Methods and Results: Levels of GDF-15 were determined in serial plasma samples (0-120 h) from 177 CS patients in the CardShock study. Kinetics of GDF-15, its association with 90-day mortality, and incremental value for risk stratification were assessed. The median GDF-15(0h) level was 9647 ng/L (IQR 4500-19,270 ng/L) and levels above median were significantly associated with acidosis, hyperlactatemia, renal dysfunction, and higher 90-day mortality (56% vs 28%, P<.001). Serial sampling showed that non-survivors had significantly higher GDF-15 levels at all time points (P<.001 for all). Furthermore, non-survivors displayed increasing and survivors declining GDF-15 levels during the first days in CS. Higher levels of GDF-15 were independently associated with mortality. A GDF-15(12h) cutoff >7000 ng/L was identified as a strong predictor of death (OR 5.0; 95% CI 1.9-3.8, P=.002). Adding GDF-15(12h) >7000 ng/L to the CardShock risk score improved discrimination and risk stratification for 90-day mortality.
Conclusions: GDF-15 levels are highly elevated in CS and associated with markers of systemic hypoperfusion and end-organ dysfunction. GDF-15 helps to discriminate survivors from non-survivors very early in CS.
Filiaciones:
Hongisto, M:
Univ Helsinki, Emergency Med, Helsinki, Finland
Helsinki Univ Hosp, Dept Emergency Med & Serv, Helsinki, Finland
Kataja, A:
Univ Helsinki, Emergency Med, Helsinki, Finland
Helsinki Univ Hosp, Dept Emergency Med & Serv, Helsinki, Finland
Tarvasmaki, T:
Univ Helsinki, Cardiol, Helsinki, Finland
Helsinki Univ Hosp, Heart & Lung Ctr, Helsinki, Finland
Holopainen, A:
Univ Eastern Finland, Inst Clin Med, Dept Clin Chem, Kuopio, Finland
ISLAB, Kuopio, Finland
Javanainen, T:
Univ Helsinki, Cardiol, Helsinki, Finland
Helsinki Univ Hosp, Heart & Lung Ctr, Helsinki, Finland
Jurkko, R:
Univ Helsinki, Cardiol, Helsinki, Finland
Helsinki Univ Hosp, Heart & Lung Ctr, Helsinki, Finland
Jantti, T:
Univ Helsinki, Cardiol, Helsinki, Finland
Helsinki Univ Hosp, Heart & Lung Ctr, Helsinki, Finland
Kimmoun, A:
Univ Lorraine, Inst Lorrain Coeur & Vaisseaux, CHRU Nancy, INSERM,U1116,Med Intens Care Unit Brabois, Nancy, France
Levy, B:
CHRU Nancy, Serv Reanimat Med Brabois, Pole Cardiomedicochirurg, F-54511 Vandoeuvre Les Nancy, France
INSERM, U1116, Fac Med, F-54511 Vandoeuvre Les Nancy, France
Univ Lorraine, Nancy, France
Mebazaa, A:
Hop Univ St Louis Lariboisiere, AP HP, INSERM, U942, Paris, France
Univ Paris Diderot, Paris, France
Pulkki, K:
Univ Turku, Dept Clin Chem, Turku, Finland
Turku Univ Hosp, Turku, Finland
Sionis, A:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Acute & Intens Cardiac Care Unit, Cardiol Dept,IIB St Pau,CIBER CV, Barcelona, Spain
Tolppanen, H:
Univ Helsinki, Cardiol, Helsinki, Finland
Helsinki Univ Hosp, Heart & Lung Ctr, Helsinki, Finland
Wollert, KC:
Hannover Med Sch, Dept Cardiol & Angiol, Hannover, Germany
Hannover Med Sch, Div Mol & Translat Cardiol, Hannover, Germany
Harjola, VP:
Univ Helsinki, Emergency Med, Helsinki, Finland
Helsinki Univ Hosp, Dept Emergency Med & Serv, Helsinki, Finland
Lassus, J:
Univ Helsinki, Cardiol, Helsinki, Finland
Helsinki Univ Hosp, Heart & Lung Ctr, Helsinki, Finland
Green Published
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