Abstract
Background GDF-15 (growth/differentiation factor 15) is induced by myocardial stretch, volume
overload, inflammation, and oxidative stress. Its expression is tightly linked with
cardiovascular events as well as the risk for major bleeding and all-cause mortality.
The present study aimed to elucidate the prognostic potential of GDF-15 in patients
after cardiac surgery.
Methods A total of 504 patients undergoing elective cardiac valve and/or coronary artery
bypass graft surgery were prospectively enrolled. GDF-15 levels were measured prior
to surgery to evaluate the impact on bleeding events, thromboembolic events, and mortality.
Results Preoperative GDF-15 was associated with the primary endpoint of intra- and postoperative
red blood cell transfusion (for bleeding risk factors adjusted [adj] OR [odds ratio]
per 1-SD [standard deviation] of 1.62 [95% confidence interval [CI]: 1.31–2.00]; p < 0.001). Higher concentrations of GDF-15 were observed in patients reaching the
secondary endpoint of major or clinically relevant minor bleeding (for bleeding risk
factors adj. OR per 1-SD of 1.70 [95% CI: 1.05–2.75]; p = 0.030) during the first postoperative year, but not for thromboembolic events.
GDF-15 was a predictor for cardiovascular mortality (for comorbidities adj. HR [hazard
ratio] per 1-SD of 1.67 [95% CI: 1.23–2.27]; p = 0.001) and all-cause mortality (for comorbidities adj. HR per 1-SD of 1.55 [95%
CI: 1.19–2.01]; p = 0.001). A combined risk model of GDF-15 and EuroSCORE II outperformed the EuroSCORE
II alone for long-term survival (C-index: 0.75 [95% CI: 0.70–0.80], p = 0.046; net reclassification improvement: 33.6%, p < 0.001).
Conclusion Preoperative GDF-15 concentration is an independent predictor for intra- and postoperative
major bleeding, major bleeding during the first year, and for long-term cardiovascular
or all-cause mortality after cardiac surgery.
Keywords
GDF-15 - postoperative atrial fibrillation - cardiac surgery - bleeding - survival
- mortality
