Growth Differentiation Factor 15: A Novel Growth Biomarker For Children With Congenital Heart Disease
Dane C. Paneitz1, Alice Zhou, BS1, Lisa Yanek1, Srujana Golla1, Sravani Avula2, Prince Kannankeril3, Allen Everett1, Bret Mettler1, Danielle Gottlieb Sen1.
1Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2Children's Medical Center Dallas, Dallas, TX, USA, 3Vanderbilt University Medical Center, Nashville, TN, USA.
Objectives: Failure to thrive (FTT), defined as weight or height less than the lowest 2.5 percentile for age, is prevalent in up to 2/3 of children with congenital heart disease (CHD). Risk stratification methods to identify those who would benefit from early intervention are currently lacking. We aimed to identify a novel growth biomarker to aid clinical decision making in children with CHD. Methods: This is a cross-sectional study of patients 2 months to 10 years of age with any CHD undergoing cardiac surgery. Preoperative weight-for-age Z scores (WAZ) and height-for-age Z scores (HAZ) were calculated and assessed for association with preoperative plasma biomarkers: growth differentiation factor 15 (GDF-15), fibroblast growth factor 21, leptin, prealbumin and C-reactive protein (CRP). Results: Of the 238 patients included, 70% of patients had WAZ/HAZ < 0 and 34% had FTT. There was a moderate correlation between GDF-15 and WAZ/HAZ (Figure). When stratified by age, the correlation of GDF-15 to WAZ and HAZ was strongest in children under 2 years of age and persisted in the setting of inflammation (CRP>0.5mg/dL). Diagnoses commonly associated with congestive heart failure had high proportions of FTT and median GDF-15 levels. FGF-21 and CRP were weakly associated with HAZ. Leptin was moderately positively correlated with WAZ. Prealbumin was not correlated with WAZ or HAZ. Conclusions: GDF-15 represents an important growth biomarker in children with CHD, especially those under 2 years of age and have diagnoses commonly associated with CHF. Our data does not support prealbumin as a long-term growth biomarker.
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