Abstract:

Objective To investigate the roles of growth differentiation factor-15（GDF-15），N-terminal pro-B-type natriuretic peptide（NT-proBNP） and neutrophil-to-lymphocyte ratio（NLR） in the diagnosis，severity assessment and prognosis evaluation of chronic heart failure（CHF）. Methods A total of 113 patients with CHF（CHF group） and 43 healthy subjects（control group） were enrolled from the Affiliated Hospital of North Sichuan Medical College from July 2023 to March 2024. The clinical data were collected，and related laboratory indicators and plasma levels of GDF-15 and NT-proBNP were determined. NLR was calculated. The patients were classified into mild group [31 cases，New York Heart Association（NYHA） classification Ⅰ-Ⅱ）] and moderate-severe group（82 cases，NYHA classification Ⅲ-Ⅳ）. All the patients were followed up for 3 months，and they were classified into endpoint event group and non-endpoint event group based on whether an endpoint event（cardiogenic death or rehospitalization due to heart failure） occurred. Logistic regression analysis was used to evaluate the influencing factors of CHF occurrence，severity and endpoint event occurrence. Receiver operating characteristic（ROC） curves were used to evaluate the efficacy of single and combined determinations in diagnosing CHF，assessing the severity of CHF，and predicting endpoint events. Results The levels of GDF-15，NT-proBNP，NLR，systemic immune-inflammation index（SII），the absolute value of neutrophils（NEUT#），the absolute value of monocytes（MO#） and red blood cell volume distribution width coefficient of variation（RDW-CV） in CHF group were all higher than those in control group（P<0.05），and the absolute value of lymphocytes（LYMPH#） was lower （P<0.05）. The levels of GDF-15，NT-proBNP，NLR and NEUT# in moderate-severe group were higher than those in mild group（P<0.05）. The levels of GDF-15，NT-proBNP，NLR，RDW-CV and red blood cell distribution width-to-platelet count ratio（RPR） in endpoint event group were higher than those in non-endpoint event group（P<0.05）. GDF-15，NT-proBNP and NLR were all risk factors for the occurrence of moderate-severe CHF and endpoint events（P<0.05）. The areas under curves（AUC） of single determinations of NT-proBNP，GDF-15 and NLR for diagnosing CHF were 0.917，0.829 and 0.764，respectively. For diagnosing moderate-severe CHF，the AUC were 0.633，0.705 and 0.715，respectively. For predicting endpoint events，the AUC were 0.689，0.799 and 0.752，respectively. The AUC of combined determinations of NT-proBNP+NLR，GDF-15+NT-proBNP and GDF-15+NLR for diagnosing CHF were 0.928，0.914 and 0.827，the AUC were 0.713，0.703 and 0.761 for diagnosing moderate-severe CHF，and the AUC were 0.773，0.795 and 0.843 for predicting endpoint events，respectively. The AUC of combined determination of the 3 indicators for diagnosing CHF was 0.906. For diagnosing moderate-severe CHF，the AUC was 0.758. For predicting endpoint events，the AUC was 0.843. Conclusions GDF-15，NT-proBNP and NLR have certain value in the diagnosis，severity assessment and prognosis evaluation of CHF.

Key words: Growth differentiation factor-15, N-terminal pro-B-type natriuretic peptide, Neutrophil-to-lymphocyte ratio, Chronic heart failure