Growth differentiation factor-15 in patients with or at risk of heart failure but before first hospitalisation


Bradley, Joshua, Schelbert, Erik B, Bonnett, Laura J ORCID: 0000-0002-6981-9212, Lewis, Gavin A, Lagan, Jakub, Orsborne, Christopher, Brown, Pamela Frances, Black, Nicholas, Naish, Josephine H, Williams, Simon G et al (show 3 more authors) (2023) Growth differentiation factor-15 in patients with or at risk of heart failure but before first hospitalisation. HEART, 110 (3). pp. 195-201.

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Abstract

<h4>Objective</h4>Identification of patients at risk of adverse outcome from heart failure (HF) at an early stage is a priority. Growth differentiation factor (GDF)-15 has emerged as a potentially useful biomarker. This study sought to identify determinants of circulating GDF-15 and evaluate its prognostic value, in patients at risk of HF or with HF but before first hospitalisation.<h4>Methods</h4>Prospective, longitudinal cohort study of 2166 consecutive patients in stage A-C HF undergoing cardiovascular magnetic resonance and measurement of GDF-15. Multivariable linear regression investigated determinants of GDF-15. Cox proportional hazards modelling, Net Reclassification Improvement and decision curve analysis examined its incremental prognostic value. Primary outcome was a composite of first hospitalisation for HF or all-cause mortality. Median follow-up was 1093 (939-1231) days.<h4>Results</h4>Major determinants of GDF-15 were age, diabetes and N-terminal pro-B-type natriuretic peptide, although despite extensive phenotyping, only around half of the variability of GDF-15 could be explained (R<sup>2</sup> 0.51). Log-transformed GDF-15 was the strongest predictor of outcome (HR 2.12, 95% CI 1.71 to 2.63) and resulted in a risk prediction model with higher predictive accuracy (continuous Net Reclassification Improvement 0.26; 95% CI 0.13 to 0.39) and with greater clinical net benefit across the entire range of threshold probabilities.<h4>Conclusion</h4>In patients at risk of HF, or with HF but before first hospitalisation, GDF-15 provides unique information and is highly predictive of hospitalisation for HF or all-cause mortality, leading to more accurate risk stratification that can improve clinical decision making.<h4>Trial registration number</h4>NCT02326324.

Item Type: Article
Uncontrolled Keywords: Heart failure, RISK STRATIFICATION
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Population Health
Depositing User: Symplectic Admin
Date Deposited: 15 Sep 2023 07:11
Last Modified: 19 Jan 2024 13:37
DOI: 10.1136/heartjnl-2023-322857
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3172767
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