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Shi G, Yue L, Tang Z, Wang Y, Hu X, Tong Y. Serum growth differentiation factor 15 as a biomarker for malnutrition in patients with acute exacerbation of chronic obstructive pulmonary disease. Front Nutr 2024; 11:1404063. [PMID: 39050134 PMCID: PMC11267996 DOI: 10.3389/fnut.2024.1404063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/28/2024] [Indexed: 07/27/2024] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a common respiratory disease that often coexists with malnutrition during acute exacerbation (AECOPD) and significantly affects the prognosis. Previous studies have shown that growth differentiation factor 15 (GDF15) levels promote appetite suppression, weight loss, and muscle weakness, and are markedly high in peripheral blood following inflammatory stimulation. However, it is still unknown whether serum GDF15 levels can be used to predict malnutrition in patients with AECOPD. Methods A total of 142 patients admitted to the Department of Respiratory Medicine at Anshun People's Hospital between December 2022 and August 2023 were selected for this study. The participants were divided into two groups: malnutrition group (n = 44) and non-malnutrition group (n = 98) based on a body mass index (BMI) < 18.5 kg/m2, according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Serum GDF15 levels were measured using the enzyme-linked immunosorbent assay (ELISA) and compared between the two groups. Spearman correlation analysis was used to examine the association between serum GDF15 levels, baseline data, and clinical indicators. Binary logistic regression was used to identify the independent risk factors for AECOPD combined with malnutrition. The predictive value of serum GDF15, albumin (ALB), and a combination of these was evaluated to identify malnutrition in patients with AECOPD using a receiver operating characteristic (ROC) curve. Results Serum GDF15 levels in patients with malnutrition and AECOPD were significantly higher than those in patients without malnutrition, whereas the serum ALB levels were significantly lower than those in patients without malnutrition (p < 0.001). Moreover, serum GDF15 levels were negatively correlated with BMI (r = -0.562, p < 0.001), mid-arm circumference (r = -0.505, p < 0.001), calf circumference (r = -0.490, p < 0.001), total protein (r = -0.486, p < 0.001), ALB (r = -0.445, p < 0.001), and prognostic nutritional index (r = -0.276, p = 0.001), and positively correlated with C-reactive protein (r = 0.318, p < 0.001), COPD assessment test score (r = 0.286, p = 0.001), modified medical research council classification (r = 0.310, p < 0.001), and global initiative for chronic obstructive pulmonary disease grade (r = 0.177, p = 0.035). Furthermore, serum GDF15 levels were an independent risk factor for malnutrition in patients with AECOPD (OR = 1.010, 95% CI, 1.003∼1.016). The optimal cut-off value of serum GDF15 level was 1,092.885 pg/mL, with a sensitivity of 65.90% and a specificity of 89.80%, while the serum ALB level was 36.15 g/L, with a sensitivity of 86.40% and a specificity of 65.00%, as well as a combined sensitivity of 84.10% and a specificity of 73.90%. Serum GDF15 and serum ALB levels had a good predictive ability (AUC = 0.856, AUC = 0.887), and the ROC revealed a greater combined prediction value for the two (AUC = 0.935). Conclusion Serum GDF15 levels could be used as a potential biomarker in the prediction of malnutrition in patients with AECOPD, offering a guidance for future clinical evaluation of malnutrition.
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Affiliation(s)
- Guifen Shi
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Longfei Yue
- Department of General Medicine, The Anshun People’s Hospital, Anshun, China
| | - Zhengying Tang
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yingling Wang
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Xiwei Hu
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yufeng Tong
- Department of Respiratory and Critical Care Medicine, The Non-directly Affiliated Anshun Central Hospital, Guizhou Medical University, Anshun, China
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Greer CE, Chew-Harris J, Adamson PD, Pemberton CJ, Pickering JW, Pilbrow AP, Frampton CM, Troughton RW, Doughty RN, Richards AM. Convalescent Growth Differentiation Factor-15 and Long-Term Outcomes after an Acute Coronary Syndrome. J Appl Lab Med 2024; 9:672-683. [PMID: 38635817 DOI: 10.1093/jalm/jfae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/01/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Growth differentiation factor-15 (GDF-15) has been shown to be associated with adverse clinical outcomes in patients after an acute coronary syndrome when measured soon after an event. Although dynamic in the acute phase after myocardial injury, GDF-15 has been shown to remain stable during convalescence. In this study, we aimed to assess the value of GDF-15 as a long-term prognostic marker for clinical outcomes when measured in the convalescent phase following an acute coronary syndrome. METHODS GDF-15 concentrations were measured in 1945 patients who were recruited between 2002 and 2009 to the Coronary Disease Cohort Study. For this analysis, follow-up was curtailed at 10 years and association of GDF-15 with all-cause death, cardiovascular death, recurrent myocardial infarction, and heart failure hospitalizations were assessed with multivariate Cox proportional hazard regression analysis. RESULTS After 10 years of follow-up, there were 648 deaths (348 from cardiovascular causes), 500 admissions for myocardial infarction, and 436 for heart failure. Four-month convalescent GDF-15 demonstrated a robust independent association with all endpoints, which remained after adjustment for Global Registry of Acute Coronary Events score and other convalescent biomarkers. When compared to the lowest quartile of GDF-15 concentrations, those in the highest quartile had a 3-fold increased risk of all-cause death. CONCLUSIONS Convalescent plasma GDF-15 is a strong and independent predictor of 10-year all-cause death, cardiovascular death, recurrent myocardial infarction, and heart failure admission following an acute coronary syndrome. AUSTRALIAN NEW ZEALAND CLINICAL TRIALS REGISTRY TRIAL ID ACTRN12605000431628.
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Affiliation(s)
- Charlotte E Greer
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Janice Chew-Harris
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Philip D Adamson
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Chris J Pemberton
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - John W Pickering
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Anna P Pilbrow
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Chris M Frampton
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Richard W Troughton
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Robert N Doughty
- Greenlane Cardiovascular Service, Te Toka Tumai Auckland Hospital, Auckland, New Zealand
- Heart Health Research Group, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - A Mark Richards
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
- Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
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Shibasaki I, Otani N, Ouchi M, Fukuda T, Matsuoka T, Hirota S, Yokoyama S, Kanazawa Y, Kato T, Shimizu R, Tezuka M, Takei Y, Tsuchiya G, Saito S, Konishi T, Ogata K, Toyoda S, Fukuda H, Nakajima T. Utility of growth differentiation factor-15 as a predictor of cardiovascular surgery outcomes: Current research and future directions. J Cardiol 2024; 83:211-218. [PMID: 37648079 DOI: 10.1016/j.jjcc.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/16/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023]
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.
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Affiliation(s)
- Ikuko Shibasaki
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, School of Medicine, Mibu, Japan.
| | - Naoyuki Otani
- Department of Cardiology, Dokkyo Medical University, Nikko Medical Center, Nikko, Japan
| | - Motoshi Ouchi
- Department of Pharmacology and Toxicology, Dokkyo Medical University, School of Medicine, Mibu, Japan; Department of Health Promotion in Nursing and Midwifery, Innovative Nursing for Life Course, Chiba University Graduate School of Nursing, Chiba, Japan
| | - Taira Fukuda
- Department of Liberal Arts and Human Development, Kanagawa University of Human Services, Yokosuka, Japan
| | - Taiki Matsuoka
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, School of Medicine, Mibu, Japan
| | - Shotaro Hirota
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, School of Medicine, Mibu, Japan
| | - Shohei Yokoyama
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, School of Medicine, Mibu, Japan
| | - Yuta Kanazawa
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, School of Medicine, Mibu, Japan
| | - Takashi Kato
- Department of Cardiovascular Surgery, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Riha Shimizu
- Department of Cardiovascular Surgery, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Masahiro Tezuka
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, School of Medicine, Mibu, Japan
| | - Yusuke Takei
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, School of Medicine, Mibu, Japan
| | - Go Tsuchiya
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, School of Medicine, Mibu, Japan
| | - Shunsuke Saito
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, School of Medicine, Mibu, Japan
| | - Taisuke Konishi
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, School of Medicine, Mibu, Japan
| | - Koji Ogata
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, School of Medicine, Mibu, Japan
| | - Shigeru Toyoda
- Department of Cardiovascular Medicine, Dokkyo Medical University, School of Medicine, Mibu, Japan
| | - Hirotsugu Fukuda
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, School of Medicine, Mibu, Japan
| | - Toshiaki Nakajima
- Department of Cardiovascular Medicine, Dokkyo Medical University, School of Medicine, Mibu, Japan
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Enoksen ITT, Rinde NB, Svistounov D, Norvik JV, Solbu MD, Eriksen BO, Melsom T. Validation of eGFR for Detecting Associations Between Serum Protein Biomarkers and Subsequent GFR Decline. J Am Soc Nephrol 2023; 34:1409-1420. [PMID: 37093083 PMCID: PMC10400103 DOI: 10.1681/asn.0000000000000147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 04/01/2023] [Indexed: 04/25/2023] Open
Abstract
SIGNIFICANCE STATEMENT eGFR from creatinine, cystatin C, or both has been primarily used in search of biomarkers for GFR decline. Whether the relationships between biomarkers and eGFR decline are similar to associations with measured GFR (mGFR) decline has not been investigated. This study revealed that some biomarkers showed statistically significant different associations with eGFR decline compared with mGFR decline, particularly for eGFR from cystatin C. The findings indicate that non-GFR-related factors, such as age, sex, and body mass index, influence the relationship between biomarkers and eGFR decline. Therefore, the results of biomarker studies using eGFR, particularly eGFRcys, should be interpreted with caution and perhaps validated with mGFR. BACKGROUND Several serum protein biomarkers have been proposed as risk factors for GFR decline using eGFR from creatinine or cystatin C. We investigated whether eGFR can be used as a surrogate end point for measured GFR (mGFR) when searching for biomarkers associated with GFR decline. METHODS In the Renal Iohexol Clearance Survey, GFR was measured with plasma iohexol clearance in 1627 individuals without diabetes, kidney, or cardiovascular disease at baseline. After 11 years of follow-up, 1409 participants had one or more follow-up GFR measurements. Using logistic regression and interval-censored Cox regression, we analyzed the association between baseline levels of 12 serum protein biomarkers with the risk of accelerated GFR decline and incident CKD for both mGFR and eGFR. RESULTS Several biomarkers exhibited different associations with eGFR decline compared with their association with mGFR decline. More biomarkers showed different associations with eGFRcys decline than with eGFRcre decline. Most of the different associations of eGFR decline versus mGFR decline remained statistically significant after adjustment for age, sex, and body mass index, but several were attenuated and not significant after adjusting for the corresponding baseline mGFR or eGFR. CONCLUSIONS In studies of some serum protein biomarkers, eGFR decline may not be an appropriate surrogate outcome for mGFR decline. Although the differences from mGFR decline are attenuated by adjustment for confounding factors in most cases, some persist. Therefore, proposed biomarkers from studies using eGFR should preferably be validated with mGFR.
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Affiliation(s)
- Inger T. T. Enoksen
- Metabolic and Renal Research Group, UiT– The Arctic University of Norway, Tromsø, Norway
| | - Nikoline B. Rinde
- Metabolic and Renal Research Group, UiT– The Arctic University of Norway, Tromsø, Norway
| | - Dmitri Svistounov
- Metabolic and Renal Research Group, UiT– The Arctic University of Norway, Tromsø, Norway
| | - Jon V. Norvik
- Metabolic and Renal Research Group, UiT– The Arctic University of Norway, Tromsø, Norway
- Section of Nephrology, Clinic of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Marit D. Solbu
- Metabolic and Renal Research Group, UiT– The Arctic University of Norway, Tromsø, Norway
- Section of Nephrology, Clinic of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Bjørn O. Eriksen
- Metabolic and Renal Research Group, UiT– The Arctic University of Norway, Tromsø, Norway
- Section of Nephrology, Clinic of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Toralf Melsom
- Metabolic and Renal Research Group, UiT– The Arctic University of Norway, Tromsø, Norway
- Section of Nephrology, Clinic of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
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Abstract
Cardiovascular disease (CVD) is prevalent in patients with chronic kidney disease (CKD) and it is responsible for approximately half of all CKD-related deaths. CVDs are the primary cause of death in hemodialysis patients due to major adverse cardiovascular events. Therefore, better approaches for differentiating chronic hemodialysis patients at higher cardiovascular risk will help physicians improve clinical outcomes. Hence, there is an urgent need to discover feasible and reliable cardiac biomarkers to improve diagnostic accuracy, reflect myocardial injury, and identify high-risk patients. Numerous biomarkers that have significant prognostic value with respect to adverse CVD outcomes in the setting of mild to severe CKD have been identified. Therefore, a better understanding of the positive clinical impact of cardiac biomarkers on CVD patient outcomes is an important step toward prevention and improving treatment in the future. In this review, we address the relationship between cardiovascular biomarkers and CKD treatment strategies to elucidate the underlying importance of these biomarkers to patient outcomes.
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Affiliation(s)
- Ying-Ju Chen
- Division of Laboratory Medicine, Asia University Hospital, Asia University, Taichung, Taiwan
| | - Chih-Chieh Chen
- Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Tze-Kiong Er
- Division of Laboratory Medicine, Asia University Hospital, Asia University, Taichung, Taiwan; Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung, Taiwan.
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Mourouzis K, Siasos G, Bozini N, Oikonomou E, Zaromitidou M, Tsigkou V, Kokkou E, Bletsa E, Stampouloglou P, Vavuranakis M, Tousoulis D. Association of Growth Differentiation Factor 15 with Arterial Stiffness and Endothelial Function in Subpopulations of Patients with Coronary Artery Disease: A Proof-of-Concept Study. RECENT ADVANCES IN INFLAMMATION & ALLERGY DRUG DISCOVERY 2023; 16:107-115. [PMID: 36336806 DOI: 10.2174/2772270817666221104120923] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 07/24/2022] [Accepted: 09/11/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Growth-differentiation factor-15 (GDF-15) is a biomarker belonging to the transforming growth factor-beta cytokine superfamily, which is linked to many pathological conditions, including inflammation and myocardial injury. Pulse wave velocity (cfPWV) and augmentation index (AIx) are indices of arterial stiffness, which are associated with the severity of coronary artery disease (CAD). Flow-mediated dilatation (FMD) is a well-studied surrogate marker of endothelial-dependent dysfunction and systemic inflammation. OBJECTIVE In this proof-of-concept study, we aimed to investigate the relationship between circulating GDF-15, endothelial dysfunction, and indices of arterial stiffness in different settings of coronary artery disease and myocardial injury. METHODS In this cross-sectional single-center study, we enrolled patients (n = 22) after interventional treatment for acute myocardial infarction (AMI), patients (n = 11) admitted with chest pain and elevated cardiac enzymes but without evidence of obstructing CAD (MI-NOCAD) in percutaneous coronary angiography (CAG), and patients (n = 20) who underwent CAG according to indications without evident obstructive CAD in CAG (NOCAD). FMD was assessed at the brachial artery. AIx of the central aortic pressure and cfPWV were estimated by applanation tonometry at the radial and carotid-femoral site, respectively, with a validated acquisition system (Sphygmo- Cor, AtCor Medical, Sydney (NSW), Australia). ELISA was used to determine circulating GDF- 15 serum levels (R&D Systems, Minneapolis, MN). Clinical and demographic data and values of routine biochemical biomarkers were obtained. The highest high-sensitive cardiac Troponin I (hsTpnI) value during hospitalization was also recorded. Left ventricular ejection fraction (LVEF) was assessed with a transthoracic echocardiogram. RESULTS Patients with AMI were older, had worse LVEF, higher values of hsTpnI and increased circulating GDF-15 levels. Importantly, AMI patients had increased cfPWV values, deteriorated AIx values, blunted FMD and worse serum creatinine levels compared to MI-NOCAD and NOCAD patients, respectively, whereas MI-NOCAD and NOCAD did not differ from each other significantly on these biomarkers. Both AMI and MI-NOCAD patients presented a higher but comparable white blood cell count than NOCAD patients. A strong linear correlation between GDF-15 and cfPWV, hsTpnI, AIx, white blood cell count and creatinine but not with FMD was demonstrated in the general study population. CONCLUSION This proof-of-concept study showed that higher circulating levels of GDF-15, an inflammatory biomarker, were associated significantly with increased arterial stiffness only in AMI patients, whereas elevated GDF-15 demonstrated a linear relationship with the severity of the myocardial injury.
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Affiliation(s)
- Konstantinos Mourouzis
- 1st Department of Cardiology, National and Kapodistrian University, Athens Medical School, Hippokration Hospital, Athens, Greece.,Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Gerasimos Siasos
- 1st Department of Cardiology, National and Kapodistrian University, Athens Medical School, Hippokration Hospital, Athens, Greece.,Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.,3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
| | - Nikoleta Bozini
- 1st Department of Cardiology, National and Kapodistrian University, Athens Medical School, Hippokration Hospital, Athens, Greece.,Department of Cardiovascular Surgery, German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Evangelos Oikonomou
- 1st Department of Cardiology, National and Kapodistrian University, Athens Medical School, Hippokration Hospital, Athens, Greece.,3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
| | - Marina Zaromitidou
- 1st Department of Cardiology, National and Kapodistrian University, Athens Medical School, Hippokration Hospital, Athens, Greece.,3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
| | - Vasiliki Tsigkou
- 1st Department of Cardiology, National and Kapodistrian University, Athens Medical School, Hippokration Hospital, Athens, Greece.,3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
| | - Eleni Kokkou
- 1st Department of Cardiology, National and Kapodistrian University, Athens Medical School, Hippokration Hospital, Athens, Greece.,3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
| | - Evanthia Bletsa
- 1st Department of Cardiology, National and Kapodistrian University, Athens Medical School, Hippokration Hospital, Athens, Greece.,3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
| | - Panagiota Stampouloglou
- 1st Department of Cardiology, National and Kapodistrian University, Athens Medical School, Hippokration Hospital, Athens, Greece.,3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
| | - Manolis Vavuranakis
- 1st Department of Cardiology, National and Kapodistrian University, Athens Medical School, Hippokration Hospital, Athens, Greece.,3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
| | - Dimitris Tousoulis
- 1st Department of Cardiology, National and Kapodistrian University, Athens Medical School, Hippokration Hospital, Athens, Greece
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Growth differentiation factor 15 (GDF-15) in kidney diseases. Adv Clin Chem 2023. [DOI: 10.1016/bs.acc.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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8
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Growth Differentiation Factor 15 (GDF-15) Levels Associate with Lower Survival in Chronic Kidney Disease Patients with COVID-19. Biomedicines 2022; 10:biomedicines10123251. [PMID: 36552007 PMCID: PMC9775159 DOI: 10.3390/biomedicines10123251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 12/15/2022] Open
Abstract
A cytokine storm drives the pathogenesis of severe COVID-19 infection and several biomarkers have been linked to mortality. Chronic kidney disease (CKD) emerged as a risk factor for severe COVID-19. We investigated the association between selected biomarkers and mortality in 77 patients hospitalized for COVID-19, and whether they differ in patients with eGFR higher and lower than 45 mL/min. The association between patients’ characteristics, plasma biomarkers and mortality was conducted by univariate logistic regression models and independent predictors of mortality were then used to create a multivariate prediction model through Cox regression. Patients with lower eGFR had a significant increase of GDF-15, CD-25 and RAGE, with higher plasma levels in non-survivors and in patients who needed ventilation. At univariate analysis, low and mid-low GDF-15 quartiles (<4.45 ng/mL) were associated with lower mortality risk, while mid-high and high quartiles (>4.45 ng/mL) were associated with higher mortality risk. Independent association between GDF-15 quartiles and mortality risk was confirmed in the Cox model and adjusted for eGFR, age, fever and dyspnea (HR 2.28, CI 1.53−3.39, p < 0.0001). The strength of the association between GDF-15 quartiles and mortality risk increased in patients with lower compared to higher eGFR (HR 2.53, CI 1.34−4.79 versus HR 1.99, CI 1.17−3.39). Our findings may suggest a further investigation of the effect of GDF-15 signaling pathway inhibition in CKD.
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9
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Wang G, Ma K, Ma Z, Guo X, Wang Y, Ma L, Qi C, Li Y, Zhou X. Short-term blood pressure variability and outcomes in non-dialysis chronic kidney disease. Front Med (Lausanne) 2022; 9:911205. [PMID: 36237550 PMCID: PMC9550867 DOI: 10.3389/fmed.2022.911205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundBlood pressure variability (BPV) is associated with cardiovascular and all-cause mortality, and has been demonstrated in dialysis patients, but has been poorly studied and remains controversial in non-dialysis chronic kidney disease (CKD) patients. We investigated the effect of short-term BPV on prognosis in this population.MethodsA total of 245 stage 1–4 CKD patients with 24-h ambulatory blood pressure recordings were recruited. BPV was evaluated by standard deviation, coefficient of variation, and variation independent of the mean, respectively. All subjects were followed up to the composite end-point event or until January 15, 2020. Patients were divided into two groups based on 24-h median variation independent of the mean, and demographics, laboratory indicators and echocardiogram results were compared. Logistic regression was used to analyze the risk factors for increased BPV. Multivariate Cox regression and Kaplan-Meier survival analysis were used to explore the relationship between BPV and renal prognosis and major cardiovascular events.ResultsThe mean age was 42.07 ± 12.66 years, with 141 males (57.55%). Multivariate Logistic regression analysis showed that high BMI (OR 1.110, P = 0.017), hyperkalemia (OR 2.227, P = 0.040), increased left ventricular end-diastolic diameter (OR 1.103, P = 0.010) and hypertension (OR 2.525, P = 0.002) were independent risk factors for high BPV. Kaplan-Meier survival analysis showed that renal and cardiovascular outcomes were better in the low BPV group than in the high BPV group (P = 0.006; P = 0.002). After adjusting for age, sex and traditional kidney related risk factors, BPV were not independently associated with renal outcomes. High BPV (HR 4.662, P = 0.017) was the main independent risk factor for major cardiovascular events in CKD.ConclusionsIn non-dialysis CKD, short-term BPV was associated with major cardiovascular disease but not renal progression. BMI, hypertension, potassium balance, and left ventricular end-diastolic diameter influenced short-term BPV.
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Affiliation(s)
- Ge Wang
- Department of Nephrology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kai Ma
- Department of Chest Surgery, Xi'an International Medical Center Hospital, Xi'an, China
| | - Zhilan Ma
- Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Xiaoyan Guo
- Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yan Wang
- Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Lan Ma
- Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Chenchen Qi
- Department of Nephrology, NO215.Hospital of Shaanxi Nuclear Industry, Xianyang, China
| | - Yan Li
- Department of Nephrology, The First People's Hospital of Yinchuan, Yinchuan, China
| | - Xiaoling Zhou
- Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan, China
- *Correspondence: Xiaoling Zhou
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Roehm B, McAdams M, Hedayati SS. Novel Biomarkers of Kidney Disease in Advanced Heart Failure: Beyond GFR and Proteinuria. Curr Heart Fail Rep 2022; 19:223-235. [PMID: 35624386 DOI: 10.1007/s11897-022-00557-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Kidney disease is a common finding in patients with heart failure and can significantly impact treatment decisions and outcomes. Abnormal kidney function is currently determined in clinical practice using filtration markers in the blood to estimate glomerular filtration rate, but the manifestations of kidney disease in the setting of heart failure are much more complex than this. In this manuscript, we review novel biomarkers that may provide a more well-rounded assessment of kidney disease in patients with heart failure. RECENT FINDINGS Galectin-3, ST2, FGF-23, suPAR, miRNA, GDF-15, and NAG may be prognostic of kidney disease progression. L-FABP and suPAR may help predict acute kidney injury (AKI). ST2 and NAG may be helpful in diuretic resistance. Several biomarkers may be useful in determining prognosis of long-term kidney disease progression, prediction of AKI, and development of diuretic resistance. Further research into the mechanisms of kidney disease in heart failure utilizing many of these biomarkers may lead to the identification of therapeutic targets.
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Affiliation(s)
- Bethany Roehm
- Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 6201 Harry Hines Boulevard, Dallas, TX, 75390, USA.
| | - Meredith McAdams
- Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 6201 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - S Susan Hedayati
- Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 6201 Harry Hines Boulevard, Dallas, TX, 75390, USA
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Lee EJ, Hwang HB, Han SH, Ham YR, Shin JA, Lee KW, Na KR, Choi DE. Serum Growth Differentiation Factor-15/Albumin Ratio as a 2-Year Survival Marker of End-Stage Renal Disease Patients Initiating Maintenance Hemodialysis. Diagnostics (Basel) 2022; 12:diagnostics12020257. [PMID: 35204349 PMCID: PMC8870838 DOI: 10.3390/diagnostics12020257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/07/2022] [Accepted: 01/19/2022] [Indexed: 02/01/2023] Open
Abstract
It is important to identify risk factors related to mortality in end-stage renal disease (ESRD) patients starting renal replacement therapy. Recently, several studies proposed that growth-differentiation factor-15 (GDF-15) is a possible biomarker for the prognosis of patients on maintenance hemodialysis. Here, we investigated the predictive value of serum GDF-15/Albumin ratio on two-year mortality in ESRD patients initiating maintenance hemodialysis. The study was a single center, retrospective study on ESRD patients starting maintenance hemodialysis with a follow-up of two years. All patients completed laboratory test and bioimpedance spectroscopy prior to the initiation of the first dialysis. The patients were stratified into quartiles according to the quartiles of serum GDF-15/Albumin ratio. Among the 159 patients, the mean age was 61.78 ± 12.52 years and median survival was 20.03 ± 7.73 months. The highest GDF-15/Albumin quartile was significantly more associated with the increased risk of all-cause mortality than other quartiles (unadjusted hazard ratio (HR): 8.468, 95% CI 2.981–24.054, p < 0.001). Older age and a higher overhydration state were associated with GDF-15/Albumin ratio. The ROC analysis confirmed that the ability of the GDF-15/Albumin ratio to predict mortality was superior to GDF-15 or albumin alone. In conclusion, the GDF-15/Albumin ratio measured at the initial maintenance hemodialysis is an independent prognostic marker of two-year mortality in ESRD patients.
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Affiliation(s)
- Eu-Jin Lee
- Department of Nephrology, Chungnam National University Hospital, Daejeon 35015, Korea; (E.-J.L.); (H.-B.H.); (S.-H.H.); (Y.-R.H.); (K.-W.L.)
| | - Haet-Bit Hwang
- Department of Nephrology, Chungnam National University Hospital, Daejeon 35015, Korea; (E.-J.L.); (H.-B.H.); (S.-H.H.); (Y.-R.H.); (K.-W.L.)
| | - Soo-Hyun Han
- Department of Nephrology, Chungnam National University Hospital, Daejeon 35015, Korea; (E.-J.L.); (H.-B.H.); (S.-H.H.); (Y.-R.H.); (K.-W.L.)
| | - Young-Rok Ham
- Department of Nephrology, Chungnam National University Hospital, Daejeon 35015, Korea; (E.-J.L.); (H.-B.H.); (S.-H.H.); (Y.-R.H.); (K.-W.L.)
| | - Jin-Ah Shin
- Department of Medical Science, Medical School, Chungnam National University, Daejeon 35015, Korea;
| | - Kang-Wook Lee
- Department of Nephrology, Chungnam National University Hospital, Daejeon 35015, Korea; (E.-J.L.); (H.-B.H.); (S.-H.H.); (Y.-R.H.); (K.-W.L.)
| | - Ki-Ryang Na
- Department of Nephrology, Chungnam National University Hospital, Daejeon 35015, Korea; (E.-J.L.); (H.-B.H.); (S.-H.H.); (Y.-R.H.); (K.-W.L.)
- Correspondence: (K.-R.N.); (D.-E.C.)
| | - Dae-Eun Choi
- Department of Nephrology, Chungnam National University Hospital, Daejeon 35015, Korea; (E.-J.L.); (H.-B.H.); (S.-H.H.); (Y.-R.H.); (K.-W.L.)
- Department of Medical Science, Medical School, Chungnam National University, Daejeon 35015, Korea;
- Correspondence: (K.-R.N.); (D.-E.C.)
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