Usefulness of GDF-15 concentrations in plasma in prognosing serious adverse events and bleeding in acute pulmonary embolism: a prospective observational study.

INTRODUCTION Growth differentiation factor 15 (GDF‑15), a cytokine induced in the myocardium by pressure overload and ischemia, has a well‑established prognostic role for diseases of the left ventricle. Plasma GDF‑15 concentrations were shown to predict bleeding events in patients with atrial fibrillation on anticoagulation. OBJECTIVES To investigate the prognostic value of GDF‑15 in acute pulmonary embolism (PE). PATIENTS AND METHODS This was a prospective observational study of 77 patients hospitalized for PE. The median length of hospital stay and follow-up was 9 days. Plasma GDF‑15 levels were measured using an automated sandwich electrochemiluminescence immunoassay. The outcome measures were: 1) in‑hospital serious adverse events (SAE; death, cardiopulmonary resuscitation, need for urgent reperfusion therapy, catecholamine administration), and 2) major bleeding or nonmajor clinically relevant bleeding. RESULTS There were 12 SAE and 5 bleeding events. The median (interquartile range) GDF‑15 concentration at admission was 2354 ng/l (1151-4750 ng/l). GDF‑15 concentrations increased according to risk subgroup. Patients with serious adverse events or bleeding events had higher baseline concentrations of GDF‑15 (median [interquartile range], 3460 ng/l [2 531-12 363 ng/l] vs 2034 ng/l [1121-4449 ng/l]; P = 0.01). The area under the curve for GDF‑15, high‑sensitivity cardiac troponin T, and N‑terminal pro-brain natriuretic peptide concentrations for predicting SAE was similar, the area under the curve of GDF‑15 levels for predicting bleeding was 0.783 (95% CI, 0.62-0.946; P = 0.001) and 0.71 (95% CI, 0.567-0.853; P = 0.004) for predicting any adverse event. In the multivariable analysis, GDF‑15 greater than 1680 ng/l emerged as an independent predictor of adverse outcomes (odds ratio, 8.9; P = 0.047). CONCLUSIONS Plasma GDF‑15 concentrations may be a promising biomarker for predicting hemodynamic destabilization and bleeding complications in PE.