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GDF-15, hs-TnT and NT proBNP for Predicting Risk of Venous Thromboembolism in Ambulatory Cancer Patients Receiving Chemotherapy.

Growth Differentiation Factor-15 (GDF-15), high-sensitivity cardiac Troponin T (hs-TnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are associated with increased risk of venous thromboembolism (VTE) in non-cancer patients. However, the performance of these biomarkers in cancer patients is unknown. Our objective was to assess performance of these biomarkers in predicting VTE in cancer patients at intermediate to high risk for VTE (Khorana Score≥2). We used 1-month plasma samples from AVERT trial patients to determine if GDF-15, NT-proBNP and hs-TnT levels are associated with VTE incidence between one- and 7-months from the start of chemotherapy. The minimal Euclidean distance of the Receiver Operating Characteristic curve was used to derive optimal cut-offs for GDF-15 and NT-proBNP given there was no evidence of a commonly used cut-off. Logistic and Fine and Gray competing risk regression analysis were used to calculate odds ratios (OR) and subdistribution hazard ratios (SHR), respectively, while adjusting for age, sex, anticoagulation and antiplatelet therapy. We tested in two groups: all patients (n=476, Model 1) and all patients with non-primary brain cancers (n=454, Model 2). In Model 1 and 2, GDF-15 ≥2290.9pg/mL had adjusted ORs for VTE of 1.65 (95%CI: 0.89-3.08), and 2.28 (95%CI: 1.28-4.09), respectively. hs-TnT ≥14.0pg/mL was associated with higher odds of VTE in Model 1 and 2 [adjusted ORs: 2.26 (95%CI: 1.40-3.65), 2.03 (95%CI: 1.07-3.84), respectively]. For NT-proBNP, levels ≥183.5pg/mL was not associated with VTE. Similar results were observed in the Fine and Gray analysis. Our results indicate that increased GDF-15 and hs-TnT levels predicted increased VTE risk.