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.

Background Among older adults with delirium and positive urinalysis, antibiotic treatment for urinary tract infection is common practice, but unsupported by literature or guidelines. We sought to: i) determine the rate of antibiotic treatment and the proportion of asymptomatic patients (other than delirium) in this patient population, and ii) examine the effect of antibiotic treatment on delirium resolution and adverse outcomes. Methods A health record review was conducted at a tertiary academic centre from January to December 2020. Inclusion criteria were age ≥ 65, positive delirium screening assessment, positive urinalysis, and admission to general medical units. Outcomes included rates of antibiotic treatment, delirium on day 7 of admission, and 30-day adverse outcomes. We compared delirium and adverse outcome rates in antibiotic-treated vs. non-treated groups. We conducted subgroup analyses among asymptomatic patients. Results We included 150 patients (57% female, mean age 85.4 years). Antibiotics were given to 86%. The asymptomatic subgroup (delirium without urinary symptoms or fever) comprised 38% and antibiotic treatment rate in this subgroup was 68%. There was no significant difference in delirium rate on day 7 between antibiotic-treated vs. non-treated groups, (entire cohort RR 0.94 [0.41–2.16] and asymptomatic subgroup RR 0.69 [0.22–2.15]) or in 30-day adverse outcomes. Conclusions Older adults with delirium and positive urinalysis in general medical inpatient units were frequently treated with antibiotics – often despite the absence of urinary or other infectious symptoms. We failed to find evidence that antibiotic treatment in this population is associated with delirium resolution on day 7 of admission.

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PurposeTo investigate the incidence and characteristics of Charles Bonnet syndrome (CBS) in patients with Leber’s hereditary optic neuropathy (LHON) via an online questionnaire shared with the LHON patient community.MethodsA recently validated French‐Canadian CBS screening questionnaire was adapted to an online bilingual (English‐French) format while being tailored to LHON patients. It was distributed to numerous mailing lists and online communities consisting of LHON patients. The 62‐item questionnaire was organized into 3 parts to cover 9 dimensions: Demographics, Screening questions for CBS, Characteristics of hallucinations, Psychological impact, Psychopathological origin, Coping strategies, Context of appearance of hallucinations, Time‐related matters, Psychosocial support. Quantitative and qualitative response data were used for cross‐sectional analysis.ResultsA total of 63 LHON patients (71% male) completed the questionnaire – with 56% screening positive for CBS. Comparing CBS‐positive and CBS‐negative patients revealed significantly different LHON mutation distributions (p = 0.01137).Among CBS‐positive patients, 74% reported experiencing hallucinations for at least one year. Furthermore, 37% said the images disturb their sleep, while 49% reported they negatively affect their mood. Additionally, only 49% had heard of CBS before and just a single patient (3%) had been diagnosed with CBS by a healthcare professional.ConclusionsThe results show there is a significant prevalence of CBS among LHON patients, but only a minority of these patients are being assessed and managed for the condition. There is also an indication that CBS tends to be long‐lasting and can be associated with various negative health outcomes. Early diagnosis and counseling of patients are important to help alleviate stress and anxiety related to CBS and improve quality of life.