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Growth Differentiation Factor 15: A Novel Growth Biomarker for Children With Congenital Heart Disease
Dane C Paneitz1, Alice Zhou2, Lisa Yanek3
1Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Insights
Growth differentiation factor 15 (GDF-15) is a promising biomarker for identifying failure to thrive in children with congenital heart disease (CHD). This finding is particularly relevant for children under two years old.
Area of Science:
- Pediatric Cardiology
- Biomarker Discovery
- Growth and Development
Background:
- Failure to thrive (FTT) affects up to 66% of children with congenital heart disease (CHD).
- Current risk stratification methods for early intervention are lacking.
- Identifying novel growth biomarkers is crucial for clinical decision-making in pediatric CHD patients.
Purpose of the Study:
- To identify a novel growth biomarker for children with CHD.
- To assess the association between plasma biomarkers and growth parameters (WAZ/HAZ).
- To aid clinical decision-making in managing FTT in pediatric CHD.
Main Methods:
- Cross-sectional study of 238 patients (2 months to 10 years) with CHD.
- Calculated preoperative weight-for-age Z scores (WAZ) and height-for-age Z scores (HAZ).
- Assessed correlations between WAZ/HAZ and plasma biomarkers: GDF-15, FGF21, leptin, prealbumin, CRP.
Main Results:
- 70% of patients had WAZ/HAZ < 0; 34% had FTT.
- Moderate correlation found between GDF-15 and WAZ/HAZ, strongest in children under 2 years.
- GDF-15 correlation persisted with inflammation (CRP > 0.5 mg/dL); prealbumin showed no correlation.
Conclusions:
- GDF-15 is a significant growth biomarker in children with CHD, especially under 2 years.
- GDF-15 is particularly relevant for children with diagnoses associated with congestive heart failure.
- Prealbumin is not supported as a long-term growth biomarker in this population.
Background:
Failure to thrive (FTT), defined as weight or height less than the lowest 2.5 percentile for age, is prevalent in up to 66% of children with congenital heart disease (CHD). Risk stratification methods to identify those who would benefit from early intervention are currently lacking. We aimed to identify a novel growth biomarker to aid clinical decision-making in children with CHD.
Methods:
This is a cross-sectional study of patients 2 months to 10 years of age with any CHD undergoing cardiac surgery. Preoperative weight-for-age Z scores (WAZ) and height-for-age Z scores (HAZ) were calculated and assessed for association with preoperative plasma biomarkers: growth differentiation factor 15 (GDF-15), fibroblast growth factor 21, leptin, prealbumin, and C-reactive protein (CRP).
Results:
Of the 238 patients included, approximately 70% of patients had WAZ/HAZ < 0 and 34% had FTT. There was a moderate correlation between GDF-15 and WAZ/HAZ. When stratified by age, the correlation of GDF-15 to WAZ and HAZ was strongest in children under 2 years of age and persisted in the setting of inflammation (CRP > 0.5 mg/dL). Diagnoses commonly associated with congestive heart failure had high proportions of FTT and median GDF-15 levels. Prealbumin was not correlated with WAZ or HAZ.
Conclusions:
GDF-15 represents an important growth biomarker in children with CHD, especially those under 2 years of age who have diagnoses commonly associated with CHF. Our data do not support prealbumin as a long-term growth biomarker.
