The combination of growth differentiation factor (GDF)-15 and N-terminal pro-brain natriuretic peptide (NT-proBNP) may provide clinicians with more accurate prognostic information in patients with systemic lupus erythematosus-associated pulmonary arterial hypertension (SLE-PAH), according to a study published in Pulmonary Circulation.

In SLE-PAH, biomarkers increasingly are being used to assess prognosis. BNP and NT-proBNP are the predominant biomarkers used, with an increase in circulating levels correlated with greater disease severity.

“However, SLE-PAH is a disease in which heterogeneity introduces major challenges in early diagnosis and risk stratification,” the authors of the study wrote. “Thus, the imperative need for novel biomarkers that may be effective in the early diagnosis and management of SLE-PAH patients remains.”

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The authors of the study investigated the merits of GDF-15, which has been proposed as an additional prognostic biomarker for SLE-PAH. They recruited patients with SLE-PAH (n=65), patients with SLE without PAH (n=51), and healthy controls (n=32), and analyzed their clinical histories and blood samples. 

Read more about PAH etiology 

The research team found that GDF-15 levels were significantly elevated in patients with SLE-PAH. In addition, this biomarker had a notable association with a number of disease parameters, such as pulmonary vascular resistance, 6-minute walk distance, and diffusing capacity for carbon monoxide. 

“In this study, we found that the combination of GDF-15 and NT-proBNP may provide more accurate prognostic information,” the authors of the study concluded. 

GDF-15 rises significantly in the face of cardiac pressure overload, inflammation, and oxidative stress. It affects the proliferation and migration of pulmonary endothelial cells, meaning it may play an important role in PAH pathogenesis. In addition, studies indicate that GDF-15 correlates with pulmonary vascular resistance and an increase in pulmonary arterial wedge pressure. 

PAH is a severe vascular complication in patients with SLE. Studies suggest it is the third leading cause of mortality in this group of patients.


Qian J, Ding Y, Yang X, et al. The diagnostic and prognostic value of growth differentiation factor-15 in systemic lupus erythematosus-associated pulmonary arterial hypertensionPulm Circ. 2023;13(1):e12195. doi:10.1002/pul2.12195