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Utility of growth differentiation factor-15 as a predictor of cardiovascular surgery outcomes: Current research and
Ikuko Shibasaki1, Naoyuki Otani2, Motoshi Ouchi3
1Department of Cardiac and Vascular Surgery, Dokkyo Medical University, School of Medicine, Mibu, Japan.
Insights
Growth differentiation factor-15 (GDF-15) shows promise as a novel biomarker for assessing cardiac surgery risk. Elevated GDF-15 levels correlate with adverse outcomes, potentially improving patient risk stratification beyond traditional methods.
Area of Science:
- Cardiology
- Biomarkers
- Geriatric Medicine
Background:
- Cardiovascular diseases (CVDs) and an aging population necessitate improved cardiac surgery risk assessment.
- Traditional risk calculators may not fully account for factors like frailty and sarcopenia.
- Growth differentiation factor-15 (GDF-15) is an emerging biomarker linked to sarcopenia and cardiac risk.
Purpose of the Study:
- To review traditional cardiac surgery risk assessment tools.
- To explore the role of GDF-15 as a novel biomarker in cardiac surgery.
- To evaluate the prognostic significance of preoperative GDF-15 levels.
Main Methods:
- Literature review of traditional cardiac surgery risk calculators.
- Analysis of studies investigating GDF-15 as a biomarker.
- Examination of GDF-15's association with patient outcomes and mortality.
Main Results:
- Elevated preoperative plasma GDF-15 levels are associated with adverse surgical factors and mortality.
- GDF-15 correlates with cardiopulmonary bypass use, bleeding, acute kidney injury, and ICU stay.
- Incorporating GDF-15 into risk models enhances predictive accuracy compared to NT-proBNP.
Conclusions:
- GDF-15 shows significant prognostic value in cardiac surgery patients.
- GDF-15 may improve risk stratification, especially for frailty and sarcopenia.
- Further research is needed to define GDF-15's normal range and therapeutic potential.
Abstract:
In a world increasingly confronted by cardiovascular diseases (CVDs) and an aging population, accurate risk assessment prior to cardiac surgery is critical. Although effective, traditional risk calculators such as the Japan SCORE, Society of Thoracic Surgeons score, and EuroSCORE II may not completely capture contemporary risks, particularly due to emerging factors such as frailty and sarcopenia. These calculators often focus on regional and ethnic specificity and rely heavily on evaluations based on age and underlying diseases. Growth differentiation factor-15 (GDF-15) is a stress-responsive cytokine that has been identified as a potential biomarker for sarcopenia and a tool for future cardiac risk assessment. Preoperative plasma GDF-15 levels have been associated with preoperative, intraoperative, and postoperative factors and short- and long-term mortality rates in patients undergoing cardiac surgery. Increased plasma GDF-15 levels have prognostic significance, having been correlated with the use of cardiopulmonary bypass during surgery, amount of bleeding, postoperative acute kidney injury, and intensive care unit stay duration. Notably, the inclusion of preoperative levels of GDF-15 in risk stratification models enhances their predictive value, especially when compared with those of the N-terminal prohormone of brain natriuretic peptide, which does not lead to reclassification. Thus, this review examines traditional risk assessments for cardiac surgery and the role of the novel biomarker GDF-15. This study acknowledges that the relationship between patient outcomes and elevated GDF-15 levels is not limited to CVDs or cardiac surgery but can be associated with variable diseases, including diabetes and cancer. Moreover, the normal range of GDF-15 is not well defined. Given its promise for improving patient care and outcomes in cardiovascular surgery, future research should explore the potential of GDF-15 as a biomarker for postoperative outcomes and target therapeutic intervention.
