Abstract：
BACKGROUND: Patients with inflammatory bowel disease (IBD) are at increased risk of thrombosis. They often need parenteral nutrition (PN) requiring intravenous access for prolonged periods. We assessed the risk of deep vein thrombosis (DVT) associated with peripherally inserted central catheters (PICCs) and tunneled catheters for patients with IBD receiving home PN (HPN).
METHODS: Using the Cleveland Clinic HPN Registry, we retrospectively studied a cohort of adults with IBD who received HPN between June 30, 2019 and January 1, 2023. We collected demographics, catheter type, and catheter-associated DVT (CADVT) data. We performed descriptive statistics and Poisson tests to compare CADVT rates among parameters of interest. We generated Kaplan-Meier graphs to illustrate longevity of CADVT-free survival and a Cox proportional hazard model to calculate the hazard ratio associated with CADVT.
RESULTS: We collected data on 407 patients, of which, 276 (68%) received tunneled catheters and 131 (32%) received PICCs as their initial catheter. There were 17 CADVTs with an overall rate of 0.08 per 1000 catheter days, whereas individual rates of DVT for PICCs and tunneled catheters were 0.16 and 0.05 per 1000 catheter days, respectively (P = 0.03). After adjusting for age, sex, and comorbidity, CADVT risk was significantly higher for PICCs compared with tunneled catheters, with an adjusted hazard ratio of 2.962 (95% CI=1.140-7.698; P = 0.025) and adjusted incidence rate ratio of 3.66 (95% CI=2.637-4.696; P = 0.013).
CONCLUSIONS: Our study shows that CADVT risk is nearly three times higher with PICCs compared with tunneled catheters. We recommend tunneled catheter placement for patients with IBD who require HPN infusion greater than 30 days.
METHODS: Using the Cleveland Clinic HPN Registry, we retrospectively studied a cohort of adults with IBD who received HPN between June 30, 2019 and January 1, 2023. We collected demographics, catheter type, and catheter-associated DVT (CADVT) data. We performed descriptive statistics and Poisson tests to compare CADVT rates among parameters of interest. We generated Kaplan-Meier graphs to illustrate longevity of CADVT-free survival and a Cox proportional hazard model to calculate the hazard ratio associated with CADVT.
RESULTS: We collected data on 407 patients, of which, 276 (68%) received tunneled catheters and 131 (32%) received PICCs as their initial catheter. There were 17 CADVTs with an overall rate of 0.08 per 1000 catheter days, whereas individual rates of DVT for PICCs and tunneled catheters were 0.16 and 0.05 per 1000 catheter days, respectively (P = 0.03). After adjusting for age, sex, and comorbidity, CADVT risk was significantly higher for PICCs compared with tunneled catheters, with an adjusted hazard ratio of 2.962 (95% CI=1.140-7.698; P = 0.025) and adjusted incidence rate ratio of 3.66 (95% CI=2.637-4.696; P = 0.013).
CONCLUSIONS: Our study shows that CADVT risk is nearly three times higher with PICCs compared with tunneled catheters. We recommend tunneled catheter placement for patients with IBD who require HPN infusion greater than 30 days.
摘要：
背景：炎症性肠病（IBD）患者血栓形成的风险增加。他们通常需要肠胃外营养（PN），需要长时间静脉进入。我们评估了接受家庭PN（HPN）的IBD患者与外周中心静脉导管（PICC）和隧道导管相关的深静脉血栓形成（DVT）的风险。
方法：使用克利夫兰诊所HPN注册表，我们回顾性研究了2019年6月30日至2023年1月1日期间接受HPN治疗的IBD成人队列.我们收集了人口统计,导管类型,和导管相关DVT（CADVT）数据。我们进行了描述性统计和泊松检验，以比较感兴趣的参数之间的CADVT率。我们生成了Kaplan-Meier图来说明无CADVT生存的寿命和Cox比例风险模型来计算与CADVT相关的风险比。
结果：我们收集了407名患者的数据，其中，276(68%)接受隧道导管,131(32%)接受PICC作为初始导管。有17例CADVT，总发生率为0.08/1000导管天，而PICC和隧道导管的DVT个体比率为0.16和0.05/1000导管天,分别(P=0.03)。在调整了年龄之后,性别,和合并症，与隧道导管相比，PICC的CADVT风险明显更高，调整后的风险比为2.962（95％CI=1.140-7.698；P=0.025），调整后的发生率比为3.66（95％CI=2.637-4.696；P=0.013）。
结论：我们的研究表明，与隧道导管相比，PICC的CADVT风险高出近三倍。对于需要输注HPN超过30天的IBD患者，我们建议放置隧道导管。
方法：使用克利夫兰诊所HPN注册表，我们回顾性研究了2019年6月30日至2023年1月1日期间接受HPN治疗的IBD成人队列.我们收集了人口统计,导管类型,和导管相关DVT（CADVT）数据。我们进行了描述性统计和泊松检验，以比较感兴趣的参数之间的CADVT率。我们生成了Kaplan-Meier图来说明无CADVT生存的寿命和Cox比例风险模型来计算与CADVT相关的风险比。
结果：我们收集了407名患者的数据，其中，276(68%)接受隧道导管,131(32%)接受PICC作为初始导管。有17例CADVT，总发生率为0.08/1000导管天，而PICC和隧道导管的DVT个体比率为0.16和0.05/1000导管天,分别(P=0.03)。在调整了年龄之后,性别,和合并症，与隧道导管相比，PICC的CADVT风险明显更高，调整后的风险比为2.962（95％CI=1.140-7.698；P=0.025），调整后的发生率比为3.66（95％CI=2.637-4.696；P=0.013）。
结论：我们的研究表明，与隧道导管相比，PICC的CADVT风险高出近三倍。对于需要输注HPN超过30天的IBD患者，我们建议放置隧道导管。
