Association between plasma growth differentiation factor-15 and postoperative nausea and vomiting incidence and severity: a secondary analysis of a randomised trial

Postoperative nausea and vomiting (PONV) distresses patients and hinders recovery. Identifying biomarkers can optimise prophylactic strategies. This study investigated whether plasma growth differentiation factor-15 (GDF-15) concentrations were associated with PONV in at-risk adult patients undergoing laparoscopic gastrointestinal surgery. Patients (n = 896) from a previous randomised controlled trial were included. Blood samples were collected before surgery in the pre-anaesthesia room and at the end of surgery. Plasma GDF-15 concentrations were measured using the Human GDF-15 ELISA Kit. The primary outcome was PONV, defined as nausea, retching, or vomiting, within 120 h after surgery. A total of 860 (96.0%) of patients were female. During 0-120 h after surgery, 531 (59.3%) patients experienced PONV. Unadjusted logistic models showed negative associations between preoperative and postoperative GDF-15 concentrations and PONV, but this association was not significant for postoperative concentrations after adjustment for confounders including preoperative concentrations. Compared with the first tertile of preoperative GDF-15 concentrations, the second tertile had an adjusted odds ratio (aOR) of 0.63 (95% confidence interval [CI] 0.44-0.91; P=0.013), and the third tertile had an aOR of 0.44 (95% CI 0.30-0.64; P<0.001) for PONV. Restricted cubic splines showed that PONV odds decreased rapidly until the preoperative GDF-15 concentrations were 830.36 pg ml-1 and then plateaued (P for overall <0.001, P for non-linearity=0.002). Compared with a low-maintaining trajectory, a high-increasing trajectory had an aOR of 0.64 (95% CI 0.46-0.89; P=0.008) for PONV. Lower preoperative plasma GDF-15 concentrations or low-maintaining trajectory were associated with higher odds of PONV in laparoscopic gastrointestinal surgery patients.