Purpose:

To evaluate whether Growth Differentiation Factor 15 (GDF-15) as a stress-response cytokine can help to predict long-term neurological outcome and mortality in patients with sustained return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest (OHCA). GDF-15 has been found to indicate early cell damage in several ischaemic disease conditions.

Methods:

Consecutive data of all patients with sustained ROSC after OHCA admitted to our institution and treated according to a dedicated post-resuscitation care protocol between 2019 and 2022 were collected in a database. GDF-15 serum levels was measured at admission. All patients were treated according to the “Hannover Cardiac Resuscitation Algorithm” (HaCRA), which includes progressive invasive and noninvasive diagnotics to rapidly identify the cause of arrest as well as standard intensive care accompanying therapeutic hypothermia. Relationship between GDF-15 and 30-day mortality and neurological outcome at 6 months, was analyzed, whereby neurological status was evaluated according to the cerebral performance category (CPC) scale.

Results:

Of 202 patients 89 (44%) died. Median GDF-15 levels were significantly lower in survivors (5147 ng/L (IQR: 2823-11354 ng/L) than in non-survivors (10530 ng/L (4665-18461 ng/L); p < 0.001). According to Youden-Index cut-off for GDF-15 for mortality was 7134 ng/L (AUC 0.68, 95% CI [0.60-0.75]; p<0.0001). GDF-15 was lower in patients with favorable neurological 6-month outcome (CPC 1-2) than in those with poor neurological outcome (CPC 3-5) (3227 ng/L (1760-5434 ng/L) vs. 7119 ng/L (3360-15391 ng/L); p < 0.001)). Cut-off was 7336 ng/L (AUC 0.74, 95% CI [0.67-0.81]; p<0.0001).

Conclusion:

Early measurement of GDF-15 allows reasonable assessment of poor long-term outcome such as mortality and neurological performance. However, due to the overlap of the values in the groups, this marker should not be used solely. Admission GDF-15 might serve as a useful biomarker and has the advantage of providing prediction already at admission and not with a delay within 72 hours like for NSE.