Association between plasma growth differentiation factor-15 and postoperative nausea and vomiting incidence and...

Postoperative nausea and vomiting (PONV) distresses patients and hinders recovery. Identifying biomarkers can optimise prophylactic strategies. This study investigated whether plasma growth differentiation factor-15 (GDF-15) concentrations were associated with PONV in at-risk adult patients undergoing laparoscopic gastrointestinal surgery.

Patients (n = 896) from a previous randomised controlled trial were included. Blood samples were collected before surgery in the pre-anaesthesia room and at the end of surgery. Plasma GDF-15 concentrations were measured using the Human GDF-15 ELISA Kit. The primary outcome was PONV, defined as nausea, retching, or vomiting, within 120 h after surgery.

A total of 860 (96.0%) of patients were female. During 0-120 h after surgery, 531 (59.3%) patients experienced PONV. Unadjusted logistic models showed negative associations between preoperative and postoperative GDF-15 concentrations and PONV, but this association was not significant for postoperative concentrations after adjustment for confounders including preoperative concentrations. Compared with the first tertile of preoperative GDF-15 concentrations, the second tertile had an adjusted odds ratio (aOR) of 0.63 (95% confidence interval [CI] 0.44-0.91; P=0.013), and the third tertile had an aOR of 0.44 (95% CI 0.30-0.64; P<0.001) for PONV. Restricted cubic splines showed that PONV odds decreased rapidly until the preoperative GDF-15 concentrations were 830.36 pg ml^-1 and then plateaued (P for overall <0.001, P for non-linearity=0.002). Compared with a low-maintaining trajectory, a high-increasing trajectory had an aOR of 0.64 (95% CI 0.46-0.89; P=0.008) for PONV.

Lower preoperative plasma GDF-15 concentrations or low-maintaining trajectory were associated with higher odds of PONV in laparoscopic gastrointestinal surgery patients.