Abstract: ob＜x＞jective : To study the relationship between the ex＜x＞pression level of growth differentiation factor 15 (GDF-15) at different time points and the clinical prognosis of patients with reduced ejection fraction heart failure (HFrEF) during the treatment of Sacubitril valsartan (ARNI).Methods :HFrEF patients (n = 84) who were hospitalized in the Department of Cardiology of Xu Zhou Medical Affiliated Hospital from February 2019 to December 2019 were selected for follow-up.All patients were given oral ARNI on the basis of comprehensive routine treatment after admission, and continued treatment for 12 weeks after discharge.According to whether the heart failure re-admission or all-cause death occurred within 90 days after discharge, the patients were divided into an event-free group (n = 68) and an event group (n = 16).The values of GDF-15and N-terminal pro-B-type natriuretic peptide(NT-proBNP) were measured at 2 basis points of clinical management in patients with heart failure: at discharge, during 12-week follow-up review or during re-admission for heart failure, and the results of heart failure rehospitalization or all-cause death in HFrEF patients were followed up within 12 weeks of discharge.Collect clinical examination data of all patients with heart failure, and use ELISA to detect the content of GDF-15 in patients’ plasma;Compare the general information of patients in the event-free group and the event group, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), different time nodes GDF-15, NT-proBNP change level, ARNI final dose；The ROC curve was used to evaluate the efficacy of GDF-15 and NT-proBNP levels at different time points for short-term prognosis of HFrEF patients after discharge.Results : （1）Patients in the event-free group and the event group had sex, age, body mass index BMI, course of disease, days of first hospitalization, LVEDd, LVEF, coronary heart disease, hypertension, diabetes, atrial fibrillation, dilated cardiomyopathy, use of diuretics, aldosterone receptor antagonists , β-blockers, the proportion of digoxin, etc., the difference was not statistically significant (P> 0.05), the final dose of ARNI was higher in the event-free group than in the event group (P <0.05).（2）GDF-15 level at discharge, GDF-15 and NT-proBNP levels at 12 weeks after discharge were higher in the event group than in the non-event group (P < 0.05). The GDF-15 level at 12 weeks after discharge in the event group was significantly higher than that at discharge, and that at 12 weeks after discharge in the non-event group was significantly lower than that at discharge (P<0.05). There was no statistically significant difference in the level of NT-proBNP at discharge between the event group and the non-event group (P>0.05). The level of NT-proBNP at 12 weeks after discharge in the event group was significantly higher than that at discharge, and the level of NT-proBNP at 12 weeks after discharge in the non-event group was significantly lower than that at discharge (P<0.05).（3）At discharge, GDF-15 level predicted ROCAUC =0.865 for heart failure readmission and death in HFrEF patients, with an optimal cut-off value of 3357ng/L, a sensitivity of 81.3%, and an specificity of 82.4%.Conclusion:The plasma GDF-15 level and its changes were not affected by the treatment of sacubatril valsartan, and were associated with the re-admission and mortality of HFrEF patients with early heart failure after discharge. Gdf-15 level at discharge was of certain predictive value for monitoring the adverse prognosis of HFrEF patients with heart failure.