Prognostic Value of Serum Growth Differentiation Factor-15 in Patients with Chronic Obstructive Pulmonary Disease Exacerbation

Background: Information regarding prognostic value of growth differentiation factor 15 (GDF-15) and heart-type fattyacid-binding protein (H-FABP) in patients with chronicobstructive pulmonary disease (COPD) exacerbation is limited. The aim of this study was to investigate whether serum levels of GDF-15 and H-FABP predict an adverse outcome forCOPD exacerbation. Methods: Clinical variables, including serum GDF-15 and H-FABP levels werecompared in prospectively enrolledpatients with COPD exacerbation that did or didnot experience an adverse outcome. An adverse outcome included 30-day mortalityand need for endotracheal intubation or inotropic support. Results: Ninety-seven patients were included and allocated into an adverseoutcome (n=10) or a control (n=87) group. Frequencies of mental change and PaCO2>37 mm Hg were significantly higher in the adverse outcome group (mentalchange: 30% vs. 6%, p=0.034 and PaCO2>37 mm Hg: 80% vs. 22%, p1,600pg/mL) was more common in the adverse outcome group (80% vs. 43%, p=0.041). However, serumH-FABP level andfrequency of serum H-FABP elevation (>755 pg/mL) did not differ between the two groups. Multivariate analysis showedthat an elevated serum GDF-15 and PaCO2>37 mm Hg were significant predictors of an adverse outcome (odds ratio[OR],25.8; 95% confidence interval [CI], 2.7-243.8; p=0.005 and OR, 11.8; 95% CI, 1.2-115.3; p=0.034, respectively). Conclusion: Elevated serum GDF-15 level and PaCO2>37 mm Hg were found to predict an adverse outcomeindependently in patients with COPD exacerbation, suggestingthe possibility that serum GDF-15 could be used as aprognostic biomarker of COPDexacerbation.