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DOI: 10.1055/s-0029-1246671
The perioperative course of plasma growth differentiation factor 15 (GDF15) in cardiac surgery patients and its relation to postoperative renal dysfunction
Background: Growth-Differentiation-Factor 15 (GDF15) is emerging as an independent mortality and morbidity risk factor in patients with cardiovascular disease, has been shown to modulate ischemia/reperfusion injury, and is strongly correlated with changes in glomerular filtration rate (GFR). No data are available about the time course and the prognostic relevance of GDF15 in patients undergoing on-pump cardiac surgery.
Materials and methods: As a part of an ongoing observational study we determined the perioperative time course of plasma GDF15 in 130 patients. Measurements were performed before and immediately after surgery and on the first to the third postoperative (POP) day. Data are given as median and 95% confidence intervals.
Results: Baseline GDF15 levels increased significantly until the first post-op day (baseline: 1.1 (1.1–1.3) ng/ml; after surgery: 2.1 (1.8–2.9) ng/ml; POP1: 7.7 (6.7–8.6) ng/ml), decreased thereafter, but remained elevated in comparison with baseline on POP2 (3.1 (2.6–3.7) ng/ml and POP3 (2.5 (2.1–3.1) ng/ml). Patients with postoperative renal dysfunction (creatinine increase >0.3mg/dl and/or need for renal replacement therapy (RRT)) had significantly higher pre- and perioperative GDF15 levels than those with a preserved renal function even after adjustment for baseline GFR. ROC-analysis revealed an AUC of 0.79 (0.71–0.86; p=0.0002) of baseline GDF15 levels for the need of postoperative RRT.
Conclusion: On-pump cardiac surgery significantly increases the plasma levels of GDF15. The newly shown association between preoperatively elevated GDF15 levels and postoperative renal dysfunction and the need for dialysis warrants further study since this parameter might be used as an additional parameter for risk stratification in cardiac surgery patients.