Yuan Huang,1,* Jia Chen,2,* Yanlan Yao,3,* Lu Zhang,2 Yongzhe Li,1 Jian Li2 

1Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China; 2Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China; 3Department of Clinical Laboratory, The First People’s Hospital of Longquanyi District Chengdu, Chongqing, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Yongzhe Li, Email yongzhelipumch@126.com Jian Li, Email Lijian@pumch.cn

Introduction: Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome is a rare plasma cell dyscrasia. Growth differentiation factor-15 (GDF-15) is related with renal function, but few studies have focused on it in renal impairment of POEMS syndrome.
Objective: To evaluate the potential of circulating GDF-15 concentration as a biomarker for renal function in POEMS syndrome.
Methods: 150 Chinese patients, diagnosed with POMES syndrome, were enrolled and divided into three subgroups according to their chemotherapy stage. All the patients’ medical records were retrospectively analyzed and plasma VEGF and GDF-15 were measured using ELISA kits. Treatment-naïve patients were followed up for 13± 6 months.
Results: Plasma GDF-15 concentration positively correlated with serum creatinine (r=0.4048; P< 0.0001), blood urea nitrogen (r=0.3302; P< 0.0001), risk stratification (r=0.3949; P< 0.0001), while negatively correlating with eGFR (r=− 0.5057; P< 0.0001) and albumin (r=− 0.3800; P=0.0014). GDF-15> 547.8 pg/mL provided an AUC of 0.8541 in diagnosing renal impairment (eGFR< 60mL/min/1.73m2) in POEMS syndrome. With a prevalence of renal impairment of 16.7%, GDF-15> 547.8 pg/mL showed a prominent NPV (94.9%) for the diagnosis of renal impairment in POEMS syndrome. Moreover, treatment-naïve patients with serous effusion had higher plasma GDF-15 concentration (P=0.0004) and lower eGFR (P=0.0001) than those without serous effusion. Noteworthy, baseline GDF-15 was positively correlated with ΔeGFR (r=0.4694, P=0.0044).
Conclusion: Circulating GDF-15 concentration is associated with serous effusion, renal function and risk stratification, while a plasma GDF-15 < 547.8 pg /mL can help rule out renal impairment in POEMS syndrome. Baseline plasma GDF-15 is associated with renal remission after chemotherapy.

Keywords: POEMS syndrome, growth differentiation factor 15, renal impairment, biomarker, risk stratification