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Abstract: PO0226

GDF-15 Predicts In-Hospital Mortality of Critically Ill Patients with AKI Requiring Continuous Renal Replacement Therapy: Results from a Prospective Randomized Controlled Trial

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Lim, Jeong-Hoon, Kyungpook National University School of Medicine, Daegu, Daegu, Korea (the Republic of)
  • Noh, Hee Won, Kyungpook National University School of Medicine, Daegu, Daegu, Korea (the Republic of)
  • Jeon, Soojee, Kyungpook National University School of Medicine, Daegu, Daegu, Korea (the Republic of)
  • Kim, Sejoong, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Jung, Hee-Yeon, Kyungpook National University School of Medicine, Daegu, Daegu, Korea (the Republic of)
  • Choi, Ji-Young, Kyungpook National University School of Medicine, Daegu, Daegu, Korea (the Republic of)
  • Park, Sun-Hee, Kyungpook National University School of Medicine, Daegu, Daegu, Korea (the Republic of)
  • Kim, Chan-Duck, Kyungpook National University School of Medicine, Daegu, Daegu, Korea (the Republic of)
  • Kim, Yong-Lim, Kyungpook National University School of Medicine, Daegu, Daegu, Korea (the Republic of)
  • Cho, Jang-Hee, Kyungpook National University School of Medicine, Daegu, Daegu, Korea (the Republic of)
Background

Growth differentiation factor-15 (GDF-15) is a stress-responsive cytokine that is positively associated with inflammation. This study evaluated the association between GDF-15 and in-hospital mortality among patients with severe acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT).

Methods

Among the multicenter prospective CRRT cohort between 2017 and 2019, 66 patients whose blood sample was available were analyzed. Patients were divided into three groups according to the GDF-15 concentrations. In-hospital mortality was compared using Cox proportional hazards regression model.

Results

The mean age was 67.7 ± 14.3 years and 47 (71.2%) were male. The median GDF-15 level was 7865.5 pg/mL (496.9 pg/mL in the healthy control patients). Baseline characteristics were not different among tertile groups except the severity scores (Acute Physiology and Chronic Health Evaluation II [APACHE II] and Sequential Organ Failure Assessment [SOFA]) and serum lactate level, which were higher in the third tertile. After adjusting for confounding factors, the patients with higher GDF-15 had significantly increased risk of mortality (second tertile: adjusted hazards ratio [aHR], 3.67; 95% confidence interval [CI], 1.05–12.76; P=0.041; third tertile: aHR, 6.81; 95% CI, 1.98–23.44; P=0.002). Furthermore, GDF-15 predicted in-hospital mortality (area under the curve, 0.710; 95% CI, 0.585–0.815) better than APACHE II and SOFA scores (Figure 1).

Conclusion

Serum GDF-15 concentration was elevated in AKI patients requiring CRRT, higher in more severe patients. GDF-15 is a better independent predictor for in-hospital mortality of critically ill AKI patients than the traditional risk scoring system such as APACHE II and SOFA scores.

Figure 1. Receiver operating characteristic curves of prognostic predictors for in-hospital mortality.