Growth differentiation factor (GDF) -15– a novel biomarker to assess the extent of liver fibrosis in patients with chronic liver disease?

Introduction: GDF-15 is known to provide prognostic information in patients with chronic heart failure. Patients with cirrhosis of the liver (LC) may also exhibit cardiac dysfunction that can be detected echocardiographically or by measuring the natriuretic peptide NT-proBNP. The aim of the study was to investigate the clinical value of GDF-15 in patients with chronic liver disease.

Methods: Concentrations of NT-proBNP and GDF-15 were measured in 31 patients with LC and 33 patients with liver fibrosis (LF) and compared to clinical and echocardiographic parameters.

Results: Mean levels of NT-proBNP and GDF-15 were 407.1±553.4 pg/ml and 8394.1±12664.5 pg/ml in patients with LC as compared to 59.5±51.3 pg/ml and 1359.5±821.1 pg/ml in patients with LF (p<0.001). Left ventricular diastolic dysfunction (LVDD) was diagnosed in 25/31 (80.6%) patients with LC and 8/33 (24.2%) patients with LF (p<0.001). In patients with LVDD, concentrations of NT-proBNP and GDF-15 were significantly higher as compared to patients without LVDD (p<0.01), however, NT-proBNP but not GDF-15 levels raised with the extent of LVDD. According to ROC analysis the extent of liver fibrosis was predicted best by GDF-15 with an area under the curve (AUC) of 0.93 as compared to NT-proBNP with an AUC of 0.76 or Apri-score with an AUC of 0.87.

Conclusions: 1. Patients with LC show significantly elevated concentrations of NT-proBNP and GDF-15 as compared to patients with LF. 2. In contrast to NT-proBNP, GDF-15 levels seem to reflect the extent of liver fibrosis rather than LVDD in patients with chronic liver disease.

GDF-15 - Liver fibrosis - NT-proBNP - cardiac dysfunction - liver cirrhosis