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Growth differentiation factor 15 is an early predictor for persistent organ failure and mortality in acute
Qingyuan Tan1, Cheng Hu1, Zhiyao Chen1
1From Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China.
Insights
Plasma Growth Differentiation Factor 15 (GDF15) levels measured early in acute pancreatitis (AP) can predict persistent organ failure (POF) and mortality. This biomarker aids in early risk stratification for AP patients.
Area of Science:
- Biochemistry
- Clinical Medicine
- Inflammation Research
Background:
- Persistent organ failure (POF) is a severe complication of acute pancreatitis (AP).
- Early identification of patients at risk for POF is critical for timely intervention.
- Growth Differentiation Factor 15 (GDF15), also known as Macrophage Inhibitory Cytokine 1 (MIC-1), is implicated in inflammatory processes.
Purpose of the Study:
- To investigate plasma GDF15 level changes in patients with AP.
- To assess the predictive value of GDF15 for the development of POF and mortality in AP.
Main Methods:
- A cohort of 290 consecutive AP patients admitted within 36 hours of symptom onset was studied.
- Plasma GDF15 levels were measured using enzyme-linked immunosorbent assays (ELISAs).
- Predictive performance was evaluated using receiver operating characteristic (ROC) curves and logistic regression models.
Main Results:
- Plasma GDF15 levels peaked on admission and declined by day 3 and 7.
- Admission GDF15 demonstrated significant predictive value for POF (AUC=0.847) and mortality (AUC=0.934).
- A combined model including GDF15, BISAP, and hematocrit showed high accuracy (AUC=0.925) for POF prediction.
Conclusions:
- Plasma GDF15 measurement within 48 hours of symptom onset is a valuable tool for predicting POF and mortality in AP patients.
- GDF15 aids in early risk stratification, potentially improving patient outcomes.
Objectives:
Early prediction of persistent organ failure (POF) is crucial for patients with acute pancreatitis (AP). Growth differentiation factor 15 (GDF15), also known as macrophage inhibitory cytokine 1 (MIC-1), is associated with inflammatory responses. We investigated changes in plasma GDF15 and assessed its predictive value in AP.
Methods:
The study included 290 consecutive patients with AP admitted within 36 h after symptoms onset. Clinical data obtained during hospitalization were collected. Plasma GDF15 levels were determined using enzyme-linked immunosorbent assays. The predictive value of GDF15 for POF was analyzed.
Results:
There were 105 mild, 111 moderately severe, and 74 severe AP patients. Plasma GDF15 peak level were measured on admission, and significantly declined on the 3rd and 7th day. Admission GDF15 predicted POF and mortality with areas under the curve (AUC) of 0.847 (95% confidence interval [CI] 0.798-0.895) and 0.934 (95% CI 0.887-0.980), respectively. Admission GDF15, Bedside Index of Severity in Acute Pancreatitis, and hematocrit were independent factors for POF by univariate and multivariate logistic regression, and the nomogram built on these variables showed good performance (optimism-corrected c-statistic = 0.921). The combined predictive model increased the POF accuracy with an AUC 0.925 (95% CI 0.894-0.956), a net reclassification improvement of 0.3024 (95% CI: 0.1482-0.4565, P < 0.001), and an integrated discrimination index of 0.11 (95% CI 0.0497-0.1703; P < 0.001).
Conclusions:
Plasma GDF15 measured within 48 h of symptom onset could help predict POF and mortality in AP patients.
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