■本研究的目的是检查诊断为淋巴瘤的个体中与PICC相关静脉血栓形成(PICC-RVTE)发生相关的危险因素,以及开发预测风险列线图模型。
■对2017年1月至2020年12月在云南省肿瘤医院治疗的215例淋巴瘤患者进行回顾性评估,作为培训队列;90例在安宁市第一人民医院肿瘤科治疗的淋巴瘤患者,以2021年1月至2023年9月的昆明理工大学附属队列为验证队列。采用logistic回归分析独立影响因素,开发并验证了一个列线图,并使用内部和外部数据队列对模型进行评估以进行验证。
■共选择了305例淋巴瘤患者,发生了35例(11.48%)PICC-RVTE,中位时间为13天.1~2周内发生率为65.71%。多变量分析表明,活动量,血栓形成病史(过去12个月内),ATIII,总胆固醇和D-二聚体水平与PICC-RVTE独立相关,并根据多变量分析构建了列线图。ROC分析表明,PICC-RVTE列线图的训练集(曲线下面积[AUC]=0.907,95CI:0.850-0.964)和测试集(AUC=0.896,95CI:0.782-1.000)具有良好的区分性。校准曲线显示出良好的校准能力,和决策曲线表明预测列线图的临床有用性。
■应建议患者在植入PICC导管后两周内进行彩色多普勒超声系统测试,以早期检测PICC-RVTE。经验证的列线图可用于预测PICC置管后接受至少一次化疗的淋巴瘤患者导管相关性血栓形成(CRT)的风险。没有出血倾向,近期没有抗凝剂暴露史,也没有严重的心脏,肺,肾功能不全.该模型有可能帮助临床医生为每位患者制定个性化的治疗策略。
UNASSIGNED: The objective of this study is to examine the risk factors associated with the occurrence of PICC-Related Venous Thrombosis (PICC-RVTE) in individuals diagnosed with lymphoma, as well as to develop a predictive risk nomogram model.
UNASSIGNED: A total of 215 patients with lymphoma treated at Yunnan Provincial Tumor Hospital from January 2017 to December 2020 were retrospectively evaluated as the training cohort; 90 patients with lymphoma treated at the Department of Oncology of the First People\'s Hospital of Anning, Affiliated to Kunming University of Science and Technology during the January 2021 to September 2023 were evaluated as the validation cohort. Independent influencing factors were analyzed by logistic regression, a nomogram was developed and validated, and the model was evaluated using internal and external data cohorts for validation.
UNASSIGNED: A total of 305 lymphoma patients were selected and 35 (11.48%) PICC-RVTE occurred, the median time was 13 days. The incidence within 1-2week was 65.71%. Multivariate analysis suggested that the activity amount, thrombosis history(within the last 12 months), ATIII, Total cholesterol and D-dimer levels were independently associated with PICC-RVTE, and a nomogram was constructed based on the multivariate analysis. ROC analysis indicated good discrimination in the training set (area under the curve [AUC] = 0.907, 95%CI:0.850-0.964) and the testing set (AUC = 0.896, 95%CI: 0.782-1.000) for the PICC-RVTE nomogram. The calibration curves showed good calibration abilities, and the decision curves indicated the clinical usefulness of the prediction nomograms.
UNASSIGNED: Patients should be advised to undergo color Doppler ultrasound system testing within two week after the implantation of a PICC catheter to detect PICC-RVTE at an early stage. The validated nomogram can be used to predict the risk of catheter-related thrombosis (CRT) in patients with lymphoma who received at least one chemotherapy after PICC
catheterization, no bleeding tendency, no recent history of anticoagulant exposure and no severe heart, lung, renal insufficiency. This model has the potential to assist clinicians in formulating individualized treatment strategies for each patient.