Growth differentiation factor-15 for prognostic assessment of patients with acute pulmonary embolism

Am J Respir Crit Care Med. 2008 May 1;177(9):1018-25. doi: 10.1164/rccm.200712-1786OC. Epub 2008 Feb 8.


Rationale: Growth differentiation factor (GDF)-15 is a cytokine induced in the heart after ischemia or pressure overload. Circulating levels of GDF-15 provide independent prognostic information in patients with acute coronary syndromes or heart failure.

Objectives: We investigated the prognostic value of GDF-15 in acute pulmonary embolism.

Methods: In a prospective cohort study, plasma levels of GDF-15 were determined by immunoradiometric assay in 123 consecutive patients with confirmed acute pulmonary embolism.

Measurements and main results: GDF-15 concentrations on admission ranged from 553 to 47,274 ng/L; 101 patients (82%) had GDF-15 levels above the upper limit of normal (1,200 ng/L). Patients who experienced pulmonary embolism-related complications during the first 30 days had higher baseline levels of GDF-15 (median, 6,039 [25th to 75th percentiles, 2,778 to 19,772] ng/L) compared with those with an uncomplicated course (median, 2,036 [25th to 75th percentiles, 1,279 to 3,176] ng/L; P < 0.001). By multivariable logistic regression analysis, which included clinical characteristics, cardiac biomarkers (troponin T and NT-proBNP [N-terminal propeptide of B-type natriuretic peptide]), and echocardiographic findings, GDF-15 emerged as an independent predictor of a complicated 30-day outcome (P = 0.033). The c-statistic for GDF-15 was 0.84 (95% confidence interval, 0.76-0.90), as compared with 0.72 for cardiac troponin T, and 0.65 for NT-proBNP. The ability of troponin T, NT-proBNP, and echocardiographic findings of right ventricular dysfunction to predict the risk of a complicated 30-day outcome was enhanced by GDF-15. Furthermore, multivariable Cox regression identified baseline levels of GDF-15 as an independent predictor of long-term mortality (P < 0.001).

Conclusions: GDF-15 is a promising new biomarker for risk stratification of pulmonary embolism.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Aged
  • Aged, 80 and over
  • Angiography
  • Biomarkers / blood*
  • Cytokines / blood*
  • Echocardiography
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • Follow-Up Studies
  • Growth Differentiation Factor 15
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Pulmonary Embolism / blood*
  • Pulmonary Embolism / diagnosis
  • Pulmonary Embolism / mortality
  • Radioimmunoassay
  • Retrospective Studies
  • Severity of Illness Index
  • Survival Rate
  • Tomography, X-Ray Computed
  • Troponin T / blood


  • Biomarkers
  • Cytokines
  • GDF15 protein, human
  • Growth Differentiation Factor 15
  • Troponin T