Niema KAZEM ZADEH MARAND, MD Division of Cardiology, Medical University of Vienna

The Prognostic Potential of Growth Differentiation Factor-15 on Bleeding Events and Patient Outcome after Cardiac Surgery—A Prospective Cohort Study

Thromb Haemost
DOI: 10.1055/a-1695-8327

Why did you (and your colleagues) write this paper? What was its main purpose?

NIEMA KAZEM

Considering a more personalized treatment approach in patients with cardiovascular diseases, GDF-15might summarize a specific preconditioned state of patients more accurately than clinical judgment or clinical risk scores. The biomarker is associated with bleeding events in patients with atrial fibrillation under oral anticoagulation and cardiovascular events. GDF-15 is induced, among others, by inflammation and myocardial stretch due to loss and administration of volume in terms of intraoperative major bleeding. The mentioned inducing factors also seem to play a role in the pathomechanism of postoperative atrial fibrillation. Therefore, our aim was to investigate the impact of GDF-15 in patients undergoing cardiac surgery.

What are the main conclusions? 

NIEMA KAZEM

Overall, we could show that GDF-15 levels represent the preconditioned state of patients undergoing cardiac surgery. Sicker patients had higher levels of preoperative GDF-15 and reached more often the endpoints of intra- or postoperative major bleeding and postoperative atrial fibrillation, one of the most common complications after cardiac surgery. Furthermore, looking at postoperative patients during follow-up, bleeding complications and cardiovascular mortality were consistent with higher preoperative GDF-15 levels.

What are the paper's implications? - to the public? -to medical professionals?

NIEMA KAZEM

We could expand the potential implication of GDF-15 as a marker for bleeding events and outcome in patients undergoing cardiac surgery. GDF-15 has the potential to provide information on complications during and after cardiac surgery through a single measurement and the ability to illustrate the general vulnerability of patients.

Are the findings clinically significant? Should the findings change practice? 

NIEMA KAZEM

Routine GDF-15 measurement prior cardiac surgery might be implemented to elucidate patients at high risk for adverse events. For preoperative evaluation, GDF-15 could potentially provide additional information regarding the prognostic workup in patients suitable for less invasive procedures. However, with the current state of knowledge, GDF-15 needs to be considered in a synopsis with expressive risk scores to enhance the predictive power for certain endpoints. Further trials are needed to improve the predictive potential of this novel biomarker.