Time Course of Growth Differentiation Factor-15 levels in Post-Resuscitation-Shock after Out-of-hospital Cardiac Arrest

Background: Shock is a major contributor to the poor prognosis of patients after out-of-hospital cardiac arrest (OHCA). This study investigated whether serial levels of growth differentiation factor (GDF)-15 may serve as a marker for impaired cardiovascular function in OHCA survivors. Methods: This prospective single-center study included 42 adult OHCA patients who were admitted to a tertiary university hospital. Blood was collected from each patient on day 0 (admission), and on days 1, 2, 3 and 5 after ROSC. Serum GDF-15 and NT-proBNP were measured by ELISA and compared to serum levels of 42 patients with coronary artery disease (CAD). Serial GDF-15 levels and a number of outcomes were assessed, including heart failure biomarker (NT-proBNP), left ventricular ejection fraction (LVEF), acute myocardial infarction (AMI)-related OHCA, hemodynamic instability and lactate clearance. Results: Compared to CAD controls, serum GDF-15 levels were consistently elevated from admission to day 5 in OHCA patients. Elevated GDF-15 levels in OHCA patients correlated positively with NT-proBNP levels on day 1, 3 and 5 after ROSC. OHCA patients with LVEF<40% on admission had significantly higher GDF-15 levels than those with LVEF≥40%. Patients with acute myocardial infarction (AMI)-related OHCA had higher GDF-15 levels than patients with non-AMI causes of OHCA. In addition, patients with inadequate lactate clearance and increased and prolonged need for vasopressor/inotropic support, indicating hemodynamic instability, had significantly elevated GDF-15 levels. Conclusion: Elevated GDF-15 levels are associated with AMI-related OHCA and key determinants of impaired cardiovascular function. Therefore, GDF-15 levels facilitate the identification of patients with post-resuscitation shock who require aggressive treatment. Trial Registration: German Clinical Trials Register DRKS; DRKS00009684; registered 27 November 2015; https://drks.de/search/de/trial/DRKS00009684