Application of detection of serum growth differentiation factor-15, soluble human stromalysin 2 and galectin-3 on the severity and prognosis evaluation in elderly patients with heart failure

doi:10.3877/cma.j.issn.2095-8757.2020.02.004

Abstract

Abstract:

Objective

To investigate the levels of serum growth differentiation factor-15 (GDF-15), soluble human stromalysin 2 (sST2) and galectin-3 (Gal-3) in evaluating the severity and prognosis of elderly patients with heart failure.

Methods

74 elderly patients with heart failure who were hospitalized in the First Affiliated Hospital of USTC from January 2018 to August 2018 were selected. According to the outcome of adverse events (cardiovascular death or rehospitalization due to heart failure) after 1 year of follow-up, they were divided into the event group and the event-free group. Univariate comparison was used between the two groups (the measurement data were tested by t test or rank sum test, while the count data were tested by chi-square test). Then, meaningful indicators were included in multivariate COX regression analysis. The characteristic curve (ROC) evaluates the prognostic value of combined detection of GDF-15, sST2, and Gal-3 in elderly patients with heart failure.

Results

During the follow-up period, 28 adverse events occurred (event group), no adverse events occurred in 46 cases(non-event group). GDF-15, sST2, and Gal-3 were significantly higher in the event group than in the non-event group (t=4.880, 3.325, z=-4.213, P < 0.05). Correlation analysis showed that GDF-15, sST2, Gal-3 were positively correlated with N-terminal B-type natriuretic peptide and NYHA cardiac function grades (r=0.647, 0.706, 0.471, 0.668, 0.603, 0.446, P < 0.05), GDF-15 and sST2 were positively correlated with left ventricular end-diastolic inner diameter (r=0.322, 0.289, P < 0.05), and negatively correlated with left ventricular ejection fraction (LVEF) (r=-0.262, -0.481, P < 0.05). Multivariate COX regression analysis showed that sST2 was the risk factor for adverse events in elderly patients with heart failure within one year (OR=1.032, 95%CI=1.009-1.054, P < 0.05). ROC curve results showed that the area under the curve of serum GDF-15, sST2 and Gal-3 combined detection was the highest, which was 0.851 (95%CI=0.763-0.937).

Conclusion

Serum GDF-15, sST2 and Gal-3 levels can reflect the severity of the disease in elderly patients with heart failure, and have certain prognostic value.

Key words: Growth differentiation factor-15, Soluble suppression of tumorigenicity 2, Galectin-3, Aged, Heart failure, Prognostic

Guiying Wu, Liqun Hu, Hongqi Li. Application of detection of serum growth differentiation factor-15, soluble human stromalysin 2 and galectin-3 on the severity and prognosis evaluation in elderly patients with heart failure[J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2020, 07(02): 12-16.

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References 19

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指标		事件组（28例）	无事件组（46例）	检验值	P值
年龄（岁）		72.9±7.8	71.5±6.6	t=0.855	>0.05
男性[例（%）]		15（53.6）	25（54.3）	χ²=0.004	>0.05
收缩压（mmHg）		119.4±13.2	127.8±15.6	t=1.993	<0.05
舒张压（mmHg）		77.5±10.8	80.1±12.8	t=0.907	>0.05
心率（次/min）		72.5±6.1	75.1±7.9	t=0.897	>0.05
BMI（kg/m²）		23.2±2.9	22.6±3.4	t=0.751	>0.05
NYHA心功能分级[例（%）]		?	?	?	?
?	Ⅱ级	4（14.3）	26（56.5）	χ²=11.188	<0.01
?	Ⅲ级	13（46.4）	17（37.0）	χ²=4.150	<0.05
?	Ⅳ级	11（39.3）	3（6.5）	χ²=10.138	<0.01
既往合并症[例（%）]		?	?	?	?
?	心肌梗死	9（32.1）	11（23.9）	χ²=0.598	>0.05
?	高血压	12（42.9）	21（45.7）	χ²=0.055	>0.05
?	心房颤动	8（28.6）	12（26.1）	χ²=0.054	>0.05
?	脑卒中	7（25.0）	11（23.9）	χ²=0.080	>0.05
?	糖尿病	12（42.9）	14（30.4）	χ²=1.179	>0.05
血钠（mmol/L）		135.3±6.4	137.5±4.1	t=0.986	>0.05
eGFR（ml·min^-1·1.73^-1）		79.7±25.7	95.3±23.8	t=-2.647	<0.05
空腹血糖（mmol/L）		5.09±0.76	5.12±0.87	t=0.526	>0.05
血红蛋白（g/L）		129.7±11.4	132.3±12.8	t=0.526	>0.05
LDL-C（mmol/L）		2.2±1.1	2.4±1.0	t=-0.878	>0.05
NT-proBNP（pg/ml）		6096.5（3812.5,12975.0）	2179.0（996.5,3910.0）	z=-4.999	<0.01
GDF-15（pg/ml）		546.4±249.5	311.0±165.7	t=4.880	<0.01
sST2（ng/ml）		22.3（14.1,34.0）	12.6（9.4,16.0）	z=-4.213	<0.01
Gal-3（ng/ml）		25.0±15.6	14.7±6.0	t=3.325	<0.01
LVEF（%）		50.3±11.8	56.4±10.9	χ²=-2.278	<0.05
LVEDD（mm）		58.2±8.6	52.8±6.6	t=3.041	<0.01
6 min步行试验（m）		221.7±141.7	399.4±173.3	t=-4.569	<0.01

指标		事件组（28例）	无事件组（46例）	检验值	P值
年龄（岁）		72.9±7.8	71.5±6.6	t=0.855	>0.05
男性[例（%）]		15（53.6）	25（54.3）	χ²=0.004	>0.05
收缩压（mmHg）		119.4±13.2	127.8±15.6	t=1.993	<0.05
舒张压（mmHg）		77.5±10.8	80.1±12.8	t=0.907	>0.05
心率（次/min）		72.5±6.1	75.1±7.9	t=0.897	>0.05
BMI（kg/m²）		23.2±2.9	22.6±3.4	t=0.751	>0.05
NYHA心功能分级[例（%）]		?	?	?	?
?	Ⅱ级	4（14.3）	26（56.5）	χ²=11.188	<0.01
?	Ⅲ级	13（46.4）	17（37.0）	χ²=4.150	<0.05
?	Ⅳ级	11（39.3）	3（6.5）	χ²=10.138	<0.01
既往合并症[例（%）]		?	?	?	?
?	心肌梗死	9（32.1）	11（23.9）	χ²=0.598	>0.05
?	高血压	12（42.9）	21（45.7）	χ²=0.055	>0.05
?	心房颤动	8（28.6）	12（26.1）	χ²=0.054	>0.05
?	脑卒中	7（25.0）	11（23.9）	χ²=0.080	>0.05
?	糖尿病	12（42.9）	14（30.4）	χ²=1.179	>0.05
血钠（mmol/L）		135.3±6.4	137.5±4.1	t=0.986	>0.05
eGFR（ml·min^-1·1.73^-1）		79.7±25.7	95.3±23.8	t=-2.647	<0.05
空腹血糖（mmol/L）		5.09±0.76	5.12±0.87	t=0.526	>0.05
血红蛋白（g/L）		129.7±11.4	132.3±12.8	t=0.526	>0.05
LDL-C（mmol/L）		2.2±1.1	2.4±1.0	t=-0.878	>0.05
NT-proBNP（pg/ml）		6096.5（3812.5,12975.0）	2179.0（996.5,3910.0）	z=-4.999	<0.01
GDF-15（pg/ml）		546.4±249.5	311.0±165.7	t=4.880	<0.01
sST2（ng/ml）		22.3（14.1,34.0）	12.6（9.4,16.0）	z=-4.213	<0.01
Gal-3（ng/ml）		25.0±15.6	14.7±6.0	t=3.325	<0.01
LVEF（%）		50.3±11.8	56.4±10.9	χ²=-2.278	<0.05
LVEDD（mm）		58.2±8.6	52.8±6.6	t=3.041	<0.01
6 min步行试验（m）		221.7±141.7	399.4±173.3	t=-4.569	<0.01

指标	NT-proBNP		NYHA心功能分级		LVEDD		LVEF
指标	r值	P值	r值	P值	r值	P值	r值	P值
GDF-15	0.647	<0.01	0.668	<0.01	0.322	<0.01	-0.262	<0.05
sST2	0.706	<0.01	0.603	<0.01	0.289	<0.05	-0.481	<0.01
Gal-3	0.471	<0.01	0.446	<0.01	0.211	>0.05	-0.179	>0.05

指标	NT-proBNP		NYHA心功能分级		LVEDD		LVEF
指标	r值	P值	r值	P值	r值	P值	r值	P值
GDF-15	0.647	<0.01	0.668	<0.01	0.322	<0.01	-0.262	<0.05
sST2	0.706	<0.01	0.603	<0.01	0.289	<0.05	-0.481	<0.01
Gal-3	0.471	<0.01	0.446	<0.01	0.211	>0.05	-0.179	>0.05

指标	B	Wald	OR	95%CI	P值
收缩压	-0.021	2.091	0.979	0.952-1.007	>0.05
eGFR	-0.016	3.106	0.984	0.967-1.002	>0.05
NYHA心功能分级	0.888	5.040	2.429	1.119-5.273	<0.05
LVEF	0.023	1.183	1.024	0.982-1.067	>0.05
LVEDD	0.030	0.751	1.030	0.963-1.102	>0.05
GDF-15	0.000	0.139	1.000	0.998-1.003	>0.05
sST2	0.031	7.824	1.032	1.009-1.054	<0.01
Gal-3	0.023	0.802	1.024	0.973-1.077	>0.05
NT-proBNP	1.451	8.905	4.268	1.646-11.071	<0.01

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