Background

Growth differentiation factor 15 (GDF-15) is an inflammatory cytokine released in response to tissue injury. It has prognostic value in cardiovascular diseases and other acute and chronic conditions. Here, we explored the value of GDF-15 as an early predictor of neurologic outcome after an out-of-hospital cardiac arrest (OHCA).

Methods

Prospective registry study of patients in coma after an OHCA, admitted in the intensive cardiac care unit from a single university center. Serum levels of GDF-15 were measured on admission. Neurologic status was evaluated according to the cerebral performance category (CPC) scale. The relationship between GDF-15 levels and poor neurologic outcome at 6 months was analyzed.

Results

Among 62 patients included, 32 (51.6%) presented poor outcome (CPC 3–5). Patients with CPC 3–5 exhibited significantly higher GDF-15 levels (median, 17.1 [IQR, 11.1–20.4] ng/mL) compared to those with CPC 1–2 (7.6 [IQR, 4.1–13.1] ng/mL; p = 0.004). Multivariable logistic regression analyses showed that age (OR, 1.09; 95% CI 1.01–1.17; p = 0.020), home setting arrest (OR, 8.07; 95% CI 1.61–40.42; p = 0.011), no bystander cardiopulmonary resuscitation (OR, 7.91; 95% CI 1.84–34.01; p = 0.005), and GDF-15 levels (OR, 3.74; 95% CI 1.32–10.60; p = 0.013) were independent predictors of poor outcome. The addition of GDF-15 in a dichotomous manner (≥ 10.8 vs. < 10.8 ng/mL) to the resulting clinical model improved discrimination; it increased the area under the curve from 0.867 to 0.917, and the associated continuous net reclassification improvement was 0.90 (95% CI 0.48–1.44), which allowed reclassification of 37.1% of patients.

Conclusions

After an OHCA, increased GDF-15 levels were an independent, early predictor of poor neurologic outcome. Furthermore, when added to the most common clinical factors, GDF-15 improved discrimination and allowed patient reclassification.

中文翻译：

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院外心脏骤停后生长分化因子15和早期预后

背景

生长分化因子15（GDF-15）是响应组织损伤而释放的炎性细胞因子。它在心血管疾病以及其他急性和慢性疾病中具有预后价值。在这里，我们探讨了院外心脏骤停（OHCA）后GDF-15作为神经系统预后的早期预测指标的价值。

方法

OHCA后昏迷患者的前瞻性登记研究，来自单一大学中心的重症监护病房。入院时测量血清GDF-15水平。根据脑功能类别（CPC）量表评估神经系统状态。分析了6个月时GDF-15水平与不良神经系统预后之间的关系。

结果

在62名患者中，有32名（51.6％）的预后较差（CPC 3-5）。患者CPC 3-5显示出较高的显著GDF-15水平与那些比较与CPC 1-2（7.6 [IQR，4.1-13.1]毫微克/毫升（中位数，17.1 [IQR，11.1-20.4]纳克/毫升）; p  = 0.004）。多变量logistic回归分析显示年龄（OR，1.09; 95％CI 1.01–1.17; p  = 0.020），住所逮捕（OR，8.07; 95％CI 1.61–40.42; p  = 0.011），无旁观者心肺复苏（OR ，7.91； 95％CI 1.84–34.01；p  = 0.005）和GDF-15水平（OR，3.74； 95％CI 1.32-10.60；p = 0.013）是不良结果的独立预测因素。以二分法（≥10.8 vs. <10.8 ng / mL）向所得临床模型中添加GDF-15可改善区分度；它使曲线下的面积从0.867增加到0.917，并且相关的连续净重分类改善为0.90（95％CI 0.48-1.44），这允许37.1％的患者重分类。

结论

OHCA后，GDF-15水平升高是神经系统预后不良的独立，早期预测因素。此外，当添加到最常见的临床因素中时，GDF-15改善了辨别力并允许患者重新分类。