Predictive Value of GDF-15 and sST2 for Pulmonary Hypertension in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Abstract

Objective

To confirm whether growth differentiation factor-15 (GDF-15) and soluble suppression of tumorigenicity 2 (sST2) are indicators of pulmonary hypertension in acute exacerbation of chronic obstructive pulmonary disease (AECOPD-PH).

Methods

All patients admitted to the hospital with AECOPD between July 2020 and October 2021 were enrolled. The patients were then categorized into AECOPD and AECOPD-PH groups according to PH probability, and the differences in GDF-15 and sST2 serum levels in the AECOPD and AECOPD-PH groups were compared. Correlation analysis was carried out to explore the association between GDF-15 and sST2 serum levels and the length of hospital stay of patients with AECOPD-PH. Receiver operating characteristic curve analysis was used to assess the clinical significance of GDF-15 and sST2 in predicting patients with AECOPD-PH.

Results

Included in this study were 126 patients with AECOPD, including 69 with AECOPD and 57 with AECOPD-PH. The serum levels of GDF-15 and sST2 in the AECOPD-PH group were significantly higher than those in the AECOPD group (P < 0.05). There was no significant correlation between the length of hospital stay in AECOPD-PH patients and GDF-15 and sST2 serum levels (P > 0.05). The area under the curves of GDF-15, sST2, and GDF-15 + sST2 for predicting AECOPD-PH and AECOPD-PH patients with poor prognosis were >0.60 and 0.70, respectively. The optimal cutoff values of GDF-15 and sST2 for predicting AECOPD-PH were 1125.33 pg/mL and 80.68 ng/mL and 1309.72 pg/mL and 59.10 ng/mL for predicting AECOPD-PH patients with poor prognosis, respectively.

Conclusion

GDF-15 and sST2 levels may be useful in the prediction of AECOPD-PH.

Keywords:

• acute exacerbation of chronic obstructive pulmonary disease
• pulmonary hypertension
• soluble suppression of tumorigenicity 2
• growth differentiation factor-15

Abbreviations

AECOPD, acute exacerbation of chronic obstructive pulmonary disease; AECOPD-PH, pulmonary hypertension in AECOPD; AUC, area under the curve; BMI, body mass index; COPD, chronic obstructive pulmonary disease; GDF-15, growth differentiation factor-15; OI, oxygenation index; ROC, receiver operating characteristic curve; SI, smoking index; sST2, soluble suppression of tumorigenicity 2.

Highlights

1. GDF-15 and sST2 serum levels in AECOPD-PH group were remarkably higher than those in AECOPD group.

2. The AUCs of GDF-15, sST2, and GDF-15 + sST2 for predicting AECOPD-PH were >0.60.

3. The AUCs of GDF-15, sST2, and GDF-15 + sST2 for predicting poor prognosis in AECOPD-PH patients were >0.70.

Ethics Approval and Informed Consent

The research was approved from the Ethics Committee of the Third Hospital of Shanxi Medical University. Written informed consents were obtained from all participants. This study was conducted in accordance with the Declaration of Helsinki.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

Funding was provided by the Natural Science Foundation of Shanxi Province (No. 201901D111414). Funding was provided by the Research Project Supported by Shanxi Scholarship Council of China (No. 2020-178). Funding was provided by the Fund Program for the Scientific Activities of Selected Returned Overseas Professionals in Shanxi Province (No. 20200029).