# Integrating GDF-15 into Multimarker Assessment of Acute Heart Failure: Diagnostic and Prognostic Implications

## TL;DR

This study shows that GDF-15 improves the diagnosis and prognosis of acute heart failure when used with other biomarkers.

## Contribution

The study demonstrates the added value of GDF-15 in multimarker strategies for acute heart failure assessment.

## Key findings

- GDF-15 levels were significantly higher in acute heart failure patients compared to controls.
- GDF-15 improved diagnostic accuracy when combined with other biomarkers like NT-proBNP and hs-cTnI.
- Multimarker models with GDF-15 enhanced one-year risk stratification for patients with high NT-proBNP.

## Abstract

Acute heart failure (AHF) is a leading cause of hospitalization and mortality worldwide. Despite advances in biomarker-based evaluation, accurate diagnostic and prognostic stratification remains challenging in everyday clinical practice. Growth differentiation factor-15 (GDF-15) has emerged as a biomarker associated with advanced disease profiles, poor outcomes and complex underlying pathophysiological processes in heart failure (HF). This study aimed to investigate the diagnostic and prognostic value of GDF-15 in the acute setting and to evaluate its incremental role within multimarker assessment strategies. In this prospective cohort study, 60 patients hospitalized with AHF and 42 control subjects were enrolled. Circulating levels of GDF-15, N-terminal pro–B-type natriuretic peptide (NT-proBNP), and high-sensitivity cardiac troponin I (hs-cTnI) were measured at admission. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis and multivariable logistic regression. Prognostic value was evaluated for in-hospital, short-term, and one-year mortality, including multimarker models. GDF-15 levels were significantly elevated in AHF and demonstrated a favorable diagnostic profile, with high specificity and acceptable sensitivity. When integrated into multivariable diagnostic models, GDF-15 added significant value beyond established cardiac biomarkers. For prognosis, standalone biomarkers showed limited long-term discrimination, whereas multimarker approaches incorporating GDF-15 improved short-term mortality prediction and enhanced one-year risk stratification in patients with markedly elevated NT-proBNP levels. GDF-15 provides independent diagnostic and prognostic information in AHF and enhances multimarker strategies for comprehensive patient assessment, supporting its integration as a complementary biomarker in contemporary AHF evaluation.