ABSTRACT
Objective To explore the serum levels of growth differentiation factor-15 (GDF-15) in patients with acute exacerbation of chronic heart failure (CHF) and its correlation with other common indexes,to provide reference for its clinical diagnosis,treatment and prognosis.Methods Two hundred patients with acute exacerbation of CHF were selected as CHF group,and 100 matched healthy volunteers were selected as control group.Serum levels of GDF-15 and N-terminal pronatriuretic peptide (NT-proBNP) were detected,and left ventricular end diastolic diameter (LVESD),left ventricular end diastolic diameter (LVEDD),and left ventricular ejection fraction (LVEF) were measured by echocardiography within 2 hours after admitted to hospital,and after the symptoms improved of CHF group,and on health examination day of control group.Patients in CHF group were followed up to record CHF related adverse events.Correlations between GDF-15 and other indicators were analyzed by Spearman correlation analysis,and the clinical value of serum GDF-15 on diagnosing CHF was analyzed by the receiver operating characteristic curve (ROC) and the area under the curve (AUC).Results The serum levels of GDF-15 and NT-proBNP in each time-point of CHF group were all higher than those of control group (t =4.70 ～ 7.11,P ＜ 0.05 orP ＜ 0.01).The serum levels of GDF-15 and NT-proBNP had negative correlation with LVEF (r =-0.539,-0.572,P ＜ 0.01),and had positive correlation with LVESD,LVEDD,and NYHA cardiac functional grading (r =0.505 ～ 0.861,P ＜ 0.01).Serum GDF-15 had positive correlation with serum NT-proBNP (r =0.528,P ＜0.01).With the increase of serum GDF-15 level,CHF group's readmission (rate) and death (rate) were both increased (x2 =36.86,26.59,P ＜0.01).AUC of predicting readmission risk by serum GDF-15 was 0.822 (95％ CI:0.719 ～0.890,P ＜0.01),and the best predictive cutoff point was 2 876.30 ng/L (sensitivity was 91.86％,specificity was 73.27％).AUC of predicting mortality risk was 0.816 (95％ CI:0.715 ～ 0.885,P ＜ 0.01),and the best predictive cutoff point was 3 487.05 ng/L (sensitivity was 91.72％,specificity was 69.05％).Conclusions Serum GDF-15 level in patients with acute exacerbation of CHF is higher,decreases with symptoms improvement,has positive correlation with LVESD,LVEDD,and NYHA cardiac functional grading,and has negative correlation with LVEF,has higher sensitivity on predicting CHF-related adverse events,and the mechanism may be related to the activation of SMAD pathway.Therefore,it may be a promising biomarker for clinical diagnosis and prognosis of cardiovascular diseases.
ABSTRACT
Objective To investigate the effect of renal dysfunction on the prognosis of hospitalized patients with decompensated heart failure (DHF).Methods 191 patients with DHF hospitalized between June 2011 and June 2013 in Baoshan Branch of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine were enrolled. These patients were divided into three groups according to the glomerular filtration rate (eGFR): normal renal function group (eGFR ≥ 90 mL·min-1·1.73 m-2, 63 cases), mild renal function descend group (eGFR 60 - 89 mL·min-1·1.73 m-2, 80 cases) and moderate or severe renal function descend group (eGFR 0.05). The complication incidence of AMI [25.0% (12/48) vs. 10.0% (8/80)] and old myocardial infarction [31.3% (15/48) vs. 11.3% (9/80)] in moderate or severe renal function descend group was obviously higher than that in mild renal function descend group (bothP 0.05). Compared with normal renal function group, the levels of inflammatory cytokines in serum TNF-α, IL-1, IL-6, IL-8, IL-10, IL-13, and the mortality, the re-admission rates due to heart failure, rates of malignant arrhythmia in the two renal function descend groups were increased significantly, the increment being more remarkable in moderate or severe renal function descend group [TNF-α (ng/L): 235.8±20.9 vs. 121.6±10.7, IL-1 (ng/L): 345.9±40.8 vs. 203.5±34.7, IL-6 (ng/L): 502.8±64.2 vs. 321.9±53.8, IL-8 (ng/L): 723.9±210.3 vs. 431.5±110.5, IL-10 (ng/L): 155.4±23.5 vs. 103.1±13.2, IL-13 (ng/L): 184.5±27.3 vs. 136.8±20.2, the rate of mortality in the first time of hospitalization: 14.6% (7/48) vs. 5.0% (4/80), mortality within one year after discharge: 25.0% (12/48) vs. 18.0% (9/80), readmission rate due to heart failure: 47.9% (23/48) vs. 30.0% (24/80), rate of relapse of coronary events: 72.9% (35/48) vs. 37.5% (30/80), malignant arrhythmia rate: 39.6% (19/48) vs. 20.0% (16/80), allP 0.05].Conclusions The incidence of renal dysfunction in patients with DHF is relatively high, and their mortality, re-admission rate and their levels of inflammatory cytokines are high obviously. Thus, the intervention of renal dysfunction may have important significance in the improvement of their prognoses.