Role of the Perioperative Growth Differentiation Factor-15 Kinetics in Identifying Patients at High Risk for Postoperative Pulmonary Complications Following Thoracic Surgery.

OBJECTIVES

Preoperative risk prediction in thoracic surgery remains difficult for individual patients, as most risk assessment models do not include perioperative factors. We hypothesized that the perioperative kinetics of growth differentiation factor 15 (GDF-15) in patients' serum predicts the risk of postoperative pulmonary complications.

DESIGN

A single-center prospective observational cohort study.

SETTING

University hospital.

PARTICIPANTS

One hundred one consecutive adult patients undergoing non-cardiac thoracic surgery.

INTERVENTIONS: None.

MEASUREMENTS: The primary endpoint, postoperative pulmonary complications (PPC), was a composite endpoint consisting of pneumonia, severe respiratory failure, reintubation, and Acute respiratory distress syndrome. Pre- and postoperative serum GDF-15 measurements were performed.

MAIN

RESULTS

During the median postoperative hospital stay of 8.7 days (median [IQR 6.6-10.4]), 23 patients with PPC were identified. Compared to the preoperative baseline, significantly higher mean concentrations of GDF-15 were observed in patients with PPC than in patients without PPC at the end of surgery (4371 [IQR 2560-6991] v 2776 [IQR 2004-3721] pg/mL, p = 0.003) and 72 hours after surgery (5040 [IQR 3482-6527] v 2810 [2178-3935] pg/mL, p < 0.001) with a significant association of the increase in GDF-15 and the hazard ratio for PPC. In a multivariate Cox proportional hazards model, an increase in GDF-15 levels >60% at the end of surgery (hazard ratio 5.9 (95% confidence interval 1.73-20.09) and an increase of >68% 72 hours after surgery (hazard ratio) 4.1 (95% confidence interval 1.36-12.62) was significantly associated with PPC after thoracic surgery.

CONCLUSIONS

In patients undergoing thoracic surgery, perioperative assessment of GDF-15 serum kinetics helps to stratify the postoperative risk of PPC.