Most of the patients undergoing treatment for cancer require placement of a totally implantable venous access device to facilitate safe delivery of chemotherapy. However, implantable ports also increase the risk of deep vein thrombosis and related complications in this high-risk population. The objective of this study was to assess the incidence of upper-extremity deep vein thrombosis (UEDVT) in patients with breast cancer to determine whether the risk of UEDVT was higher with chest versus arm ports, as well as to determine the importance of previously reported risk factors predisposing to UEDVT in the setting of active cancer. We retrospectively reviewed the medical records of 297 women with breast cancer who had ports placed in our institution between the dates of December 1, 2010, and December 31, 2016. The primary outcome was the development of radiologically confirmed UEDVT ipsilateral to the implanted port. Overall, 17 of 297 study subjects (5.7%) were found to have UEDVT. There was 1 documented case of associated pulmonary embolism. Fourteen (9.5%) of 147 subjects with arm ports experienced UEDVT compared with only 3 (2.0%) of 150 subjects with chest ports (P = .0056). Thus, implantation of arm ports as opposed to chest ports may be associated with a higher rate of UEDVT in patients with breast cancer.

This retrospective, observational cohort study of mechanically ventilated patients at 21 community and 2 academic hospitals demonstrated that in 28,758 derivation cohort admissions, every 10% increase in SpO2/ FiO2 time at risk (SF-TAR) was associated with a 24% increase in adjusted odds of hospital mortality. The SF-TAR can identify ventilated patients at increased risk of death, offering modest improvements compared with single SpO2/FiO2 and P/F ratios. This longitudinal, noninvasive, and broadly generalizable tool may have particular utility for early phenotyping and risk stratification.

e21645 Background: C-Reactive Protein (CRP) is an acute phase reactant which is elevated in inflammatory conditions and malignancy. Elevated CRP levels are associated with poor prognosis in many cancers and has been reported in patients with melanoma treated with ICI. We examined the association between CRP levels during therapy with ICI in patients with advanced lung cancer and radiological response. Methods: A retrospective study of patients with metastatic lung cancer (stage IV) who were treated with immunotherapy from 2016 to 2019 was conducted. CRP levels were checked at or soon after initiation of therapy and at frequent intervals thereafter. Association between CRP levels and response was determined. Results: 36 patients had initial (at the beginning of therapy, baseline) and subsequent CRP levels recorded during the first course of immunotherapy. Among the 36 patients, 16 (44%) had radiological response or stable disease, and 20 (55%) had radiological progression. The median age was 69 years (range 50 – 89 years); male/female 35/1, Caucasian/African American/other 26/9/1. There was no significant difference in distribution of initial CRP levels between patients with response vs progression as assessed by Kruskal-Wallis test (P-val: 0.20). Logistic regression modeling was employed to examine the association between final CRP level, the last measurement while on ICI therapy (adjusted for baseline CRP level) and odds of observing a response. A unit increase in final CRP level was associated with 4% decrease in odds of observing a response (Odds Ratio, 95% CI: 0.96, 0.92-1.00, P-val: 0.05). Conclusions: Baseline-adjusted final CRP levels were inversely associated with likelihood of observing a response in advanced lung cancer subjects treated with ICI. Further validation in prospective studies is warranted.

The measurement of cardiac troponin, released from injured cardiomyocytes, is of paramount importance in the diagnosis of acute myocardial infarction. Elevated troponin can be encountered, however, in patients with cardiomyopathy, significant cardiac arrhythmias, vasculitis, right-sided heart strain, critical systemic illnesses, stroke, drug toxicity (such as Adriamycin), poisons (such as snake venoms), renal failure, seizure, and rhabdomyolysis. If the clinical picture is not consistent with any of these causes, a false-positive result should be considered. We herein describe a 94-year-old man with a prior history of coronary artery disease who presented with altered mental status and was found to have a persistently high troponin level resulting in three admissions to the coronary care unit for various noncardiac complaints. Because of discordance between clinical and laboratory data, immunological interference due to heterophile antibodies in the locally used assay (AccuTnI+3, Beckman Coulter) was suspected. The same serum sample tested on a different assay (Elecsys Troponin I Assay, Roche) resulted in an undetectable cardiac troponin I level, thus confirming the diagnosis.

42 Background: Advance Directive (AD) completion is particularly more important in patients with cancer given the higher mortality associated with the diagnoses as well as the treatments that patients receive. In reality AD discussion and completion rate is influenced by patient characteristics and disease status. We undertook a Quality improvement project to improve AD discussion and completion in inpatient hematology unit at our institution. Methods: Plan-Do-Study-Act (PDSA) methodology was used and the team consisted of residents and case managers. Each morning electronic medical record (EMR) was reviewed and new patients admitted to hematology unit were identified for a period of 1 month. Patients without an AD on file were educated by a designated resident and were given forms to file AD. Based on the patient’s willingness, the case manager was alerted with daily communication email to follow-up and assist in completion and filing of AD into EMRs. Results: AD on discharge on a randomly chosen pre-intervention month was 6.97% which improved to 42% post intervention. Conclusions: Compared to Oncology patients, Hematology patients have a lower rate of AD completion in general. Hematology patients are usually younger, have a higher chance of achieving remission, and usually have improved survival with stem cell transplant due to which AD discussion does not happen very often. The notion of having AD discussion only for patients with poor prognosis should change and must be offered to everyone. We found an improvement in AD filing rate by increasing physician involvement and streamlining the process with designated roles. It is the responsibility of physicians to discuss Advance Care Planning (ACP) with their patients and readdress them at appropriate intervals as disease status can change. [Table: see text]