Growth Differentiation Factor-15 Predicts Major Bleeding in Cancer Patients

Figures

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  Figure 1. Cumulative Incidence of Major Bleeding According to GDF-15 Level Patients were stratified by growth differentiation factor (GDF)-15 level, with the group higher than 1,864 ng/L (the median value) compared with the group at or lower than 1,864 ng/L using Gray’s test for competing risks.

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  Figure 2. Six-Month Predicted Probabilities of Major Bleeding in Relation to Continuous GDF-15 Levels This analysis was based on Gray’s model incorporating growth differentiation factor (GDF)-15 with restricted cubic splines and accounting for all-cause death as a competing risk. The x-axis was log10 transformed. Predicted probabilities are shown up to the 95th percentile of GDF-15 levels, which range from 400 to 59,707 ng/L. The dashed line represents the cohort median GDF-15 level.

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  Figure 3. Association of GDF-15 With Major Bleeding in Univariable and Multivariable Analyses Subdistribution HRs (SHRs) are displayed for log2-transformed levels of growth differentiation factor (GDF)-15. The SHR represents the risk increase associated with each doubling of GDF-15 level. All-cause death was considered a competing risk. Patients with head and neck cancer were classified as high risk for bleeding, and adjustment for head and neck vs other tumor types was performed. BMI = body mass index; GGT = gamma-glutamyl transferase.

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  Figure 4. 6-Month Predicted Probabilities of All-Cause Death in Relation to Continuous GDF-15 Levels The x-axis was log10 transformed. Predicted probabilities are shown up to the 95th percentile of growth differentiation factor (GDF)-15 levels, which range from 400 to 59,707 ng/L. The dashed line represents the cohort median GDF-15 level.

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  Figure 5. Association of GDF-15 With All-Cause Mortality in Univariable and Multivariable Analyses HRs are displayed for log2-transformed levels of GDF-15. The hazard ratio represents the risk increase associated with each doubling of GDF-15 levels. Abbreviations as in Figure 3.

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  Central Illustration. GDF-15 Predicts 6-Month Major Bleeding Risk in Patients With Cancer This illustration summarizes the study cohort, outcomes of interest, and key results of the analyses on growth differentiation factor (GDF)-15 in cancer patients. GDF-15 demonstrated an independent association with major bleeding risk and all-cause mortality but showed no association with venous thromboembolism (VTE) risk. Evaluated bleeding risk scores, including HAS-BLED and CAT-BLEED, showed improved performance when GDF-15 was incorporated. GDF-15 alone effectively predicted 6-month major bleeding risk.