{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T22:25:13Z","timestamp":1791498313609,"version":"4.3.4"},"reference-count":16,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: C-reactive protein (CRP) is a well-established marker of systemic inflammation, while Growth Differentiation Factor-15 (GDF-15) has emerged as a potential biomarker of cellular stress. Their relative perioperative dynamics remain incompletely defined. This prospective observational study aimed to explicitly characterize and compare the longitudinal dynamics of CRP and GDF-15 in patients undergoing elective knee arthroplasty. Characterizing these biomarkers in a controlled acute surgical model provides clinical relevance by mapping systemic acute-phase inflammation against cellular stress pathways, which may offer a baseline reference for evaluating chronic tissue-wasting states. Methods: This prospective observational study included 47 patients undergoing elective knee arthroplasty. After excluding nine patients with elevated baseline CRP (&gt;10 mg\/L), serial measurements of CRP and GDF-15 were analysed daily in 38 patients from pre-operation to postoperative Days 1\u20133. Results: CRP rose sharply after surgery, peaking on Day 3 (median: 206.0 mg\/L vs. baseline: 3.0 mg\/L), representing a maximal increase exceeding 6100%. GDF-15 levels also increased progressively, peaking on Day 3 (median: 1682.5 pg\/mL vs. baseline: 968.8 pg\/mL), which represented a statistically significant but more modest rise of 33%. CRP and GDF-15 were significantly correlated on postoperative day 1 (rs = 0.53, p = 0.001) but not days 2 and 3. Baseline GDF-15, but not CRP, was significantly associated with oral hypoglycaemic agent use and vitamin B12 supplementation. Compared to values reported in recent randomized trials of ghrelin, anti-GDF-15, and anti-IL-6 therapies, GDF-15 levels in this surgical cohort remained lower, while CRP approached levels observed in such studies. Conclusions: CRP and GDF-15 rise in parallel following surgical injury; however, GDF-15 shows a considerably lower sensitivity to the inflammatory response. These findings suggest a complementary role of GDF-15 alongside CRP in profiling the perioperative stress response. While its relatively modest acute elevation limits its utility as a primary marker of acute inflammation, this surgical stress model serves as a reference that may help contextualize biomarker profiles in chronic inflammatory or wasting conditions, such as cancer cachexia, rather than serving as a direct tool for cachexia management.<\/jats:p>","DOI":"10.3390\/nu18142255","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T09:46:47Z","timestamp":1783676807000},"page":"2255","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Tracking Perioperative Inflammation over Time: A Prospective Observational Study on the Longitudinal Dynamics of CRP and GDF-15"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7754-7229","authenticated-orcid":false,"given":"Chattarin","family":"Pumtako","sequence":"first","affiliation":[{"name":"Academic Unit of Surgery, School of Medicine, College of Medical Veterinary & Life Sciences, University of Glasgow, Glasgow G12 8TB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald C.","family":"McMillan","sequence":"additional","affiliation":[{"name":"Academic Unit of Surgery, School of Medicine, College of Medical Veterinary & Life Sciences, University of Glasgow, Glasgow G12 8TB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barry J.","family":"Laird","sequence":"additional","affiliation":[{"name":"Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5272-5906","authenticated-orcid":false,"given":"Ross D.","family":"Dolan","sequence":"additional","affiliation":[{"name":"Academic Unit of Surgery, School of Medicine, College of Medical Veterinary & Life Sciences, University of Glasgow, Glasgow G12 8TB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M.","family":"Wadsworth","sequence":"additional","affiliation":[{"name":"Scottish Trace Element and Micronutrient Diagnostic and Research Laboratory, Department of Clinical Biochemistry, Macewan Building, Glasgow Royal Infirmary, Glasgow G4 0SF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0317-4079","authenticated-orcid":false,"given":"Donogh","family":"Maguire","sequence":"additional","affiliation":[{"name":"Emergency Medicine Department, Glasgow Royal Infirmary, Glasgow G4 0SF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1016\/j.amjmed.2007.08.037","article-title":"C-Reactive Protein, Inflammatory Conditions, and Cardiovascular Disease Risk","volume":"120","author":"Dhingra","year":"2007","journal-title":"Am. 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Ther."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/14\/2255\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T09:54:05Z","timestamp":1783677245000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/14\/2255"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,10]]},"references-count":16,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["nu18142255"],"URL":"https:\/\/doi.org\/10.3390\/nu18142255","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,10]]}}}