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Critical Care

, 17:R92

First Online: 24 May 2013Received: 13 December 2012Revised: 11 March 2013Accepted: 24 May 2013

Abstract

IntroductionWe sought to determine whether higher levels of the novel biomarker growth differentiation factor-15 GDF-15 are associated with poor outcomes and the presence of pulmonary vascular dysfunction PVD in patients with acute respiratory distress syndrome ARDS.

MethodsWe conducted a retrospective cohort study in patients enrolled in the Acute Respiratory Distress Syndrome Network Fluid and Catheter Treatment FACT Trial. Patients enrolled in the FACT Trial who received a pulmonary artery catheter PAC, had plasma available from the same study day and sufficient hemodynamic data to determine the presence of PVD were included. Logistic regression was used to determine the association between GDF-15 level and 60-day mortality.

ResultsOf the 513 patients enrolled in the FACT Trial assigned to receive a PAC, 400 were included in this analysis. Mortality at 60 days was significantly higher in patients whose GDF-15 levels were in the third 28% or fourth 49% quartile when compared to patients with GDF-15 levels in the first quartile 12% P <0.001. Adjusting for severity of illness measured by APACHE III score, the odds of death for patients with GDF-15 levels in the fourth quartile when compared to the first quartile was 4.26 95% CI 2.18, 10.92, P <0.001. When added to APACHE III alone for prediction of 60-day mortality, GDF-15 levels increased the area under the receiver operating characteristic curve from 0.72 to 0.77. At an optimal cutoff of 8,103 pg-mL, the sensitivity and specificity of GDF-15 for predicting 60-day mortality were 62% 95% CI 53%, 71% and 76% 95% CI 71%, 81%, respectively. Levels of GDF-15 were not useful in identifying the presence of PVD, as defined by hemodynamic measurements obtained by a PAC.

ConclusionsIn patients with ARDS, higher levels of GDF-15 are significantly associated with poor outcome but not PVD.

KeywordsAcute respiratory distress syndrome pulmonary vascular dysfunction risk prediction growth differentiation factor-15 AbbreviationsAUCarea under the curve

APACHEacute physiology and chronic health evaluation

ARDSacute respiratory distress syndrome

BNPbrain natriuretic peptide

CNScentral nervous system

ELISAenzyme-linked immunosorbent assay

FACTFluid and Catheter Treatment

GDF-15growth differentiation factor-15

IQRinterquartile range

mPAPmean pulmonary arterial pressure

PACpulmonary artery catheter

PAHpulmonary arterial hypertension

PAOPpulmonary artery occlusion pressure

PVDpulmonary vascular dysfunction

PVRipulmonary vascular resistance index

ROCreceiver operating characteristic

TIMIthrombolysis in myocardial infarction

TPGtranspulmonary gradient.

Electronic supplementary materialThe online version of this article doi:10.1186-cc12737 contains supplementary material, which is available to authorized users.

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Autor: Brendan J Clark - Todd M Bull - Alexander B Benson - Amanda R Stream - Madison Macht - Jeanette Gaydos - Christina Mead

Fuente: https://link.springer.com/







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