Growth differentiation factor-15 and routine laboratory parameters are associated with one-year mortality in patients with end-stage heart failure undergoing heart transplantation evaluation.

ABSTRACT

BACKGROUND: Growth differentiation factor-15 (GDF-15) is a hormone that regulates inflammatory responses, tissue repair, and cardiac remodeling, the three key processes underlying the development and progression of heart failure (HF). Furthermore, GDF-15 integrates information from cardiac and extracardiac disease pathways that are linked to multiorgan dysfunction in advanced stages of HF. AIM: This study aimed to determine which factors are associated with one-year mortality in patients with end-stage HF, with particular emphasis on GDF-15. METHODS: We prospectively analyzed 315 consecutive hospitalized patients with end-stage HF who underwent heart transplantation evaluation between 2018 and 2022. The endpoint was all-cause mortality during one-year follow-up. We measured routine laboratory parameters and the serum GDF-15 concentration using a sandwich enzyme-linked immunosorbent assay (ELISA) (SunRedBio Technology Co, Ltd, Shanghai, China). RESULTS: The median age of the patients was 57 (50-62) years. During follow-up, 97 patients died. Higher serum concentrations of GDF-15 (hazard ratio [HR], 1.119; 95% CI, 1.095-1.144; P <0.001), high-sensitivity C-reactive protein (HR, 1.140; 95% CI, 1.037-1.253; P = 0.006), fibrinogen (HR, 1.003; 95% CI, 1.001-1.005; P = 0.003), bilirubin (HR, 1.055; 95% CI, 1.027-1.084; P <0.001), N-terminal pro-B-type natriuretic peptide (HR, 1.342; 95% CI, 1.206-1.493; P <0.001), and gamma-glutamyl transpeptidase (HR, 1.007; 95% CI, 1.002-1.012; P = 0.003) were independently associated with one-year mortality. CONCLUSIONS: Higher GDF-15, high-sensitivity C-reactive protein, fibrinogen, bilirubin, gamma-glutamyl transpeptidase, and N-terminal pro-B-type natriuretic peptide concentrations were independently associated with worse survival in patients with end-stage HF.