背景:血浆生物标志物的测量和鉴定可以支持与使用外周插入中心静脉导管(PICC)相关的深静脉血栓形成(DVT)的风险估计和诊断。
目的:本系统综述和荟萃分析旨在确定反映血液系统激活的潜在生物标志物水平之间的关联。长期血管并发症,炎症系统,以及PICC相关DVT的发生。
方法:七个电子数据库(Embase,WebofScience,Medline,Scopus,Cinahl,Cochrane中央控制试验登记册,和ERIC)进行搜索,以确定直到2022年12月发表的文献。研究需要报告:(I)成人和儿科患者,门诊或临床住院,外科,或具有PICC的ICU;(II)具有PICC相关DVT的患者和没有PICC相关DVT的患者作为比较物;和(III)至少一种可用的生物标志物。纽卡斯尔-渥太华量表用于评估研究质量。通过使用血小板水平的漏斗图评估研究精度。我们提供了对生物标志物研究结果的叙述性综合和荟萃分析。我们使用随机效应荟萃分析汇总了结果。使用ReviewManager软件v5.4进行荟萃分析。本系统评价在PROSPERO(CRD42018108871)中注册。
结果:在确定的3564项研究中(重复删除后),28人包括在内。PICC相关的DVT与较高的D-二聚体(0.37μg/mL,95%CI0.02,0.72;p=0.04,I2=92%;异质性p<0.00001),血小板较高(8.76×109/L,95%CI1.62,15.91;p=0.02,I2=41%;异质性p=0.06)。
结论:在PICC置管患者中,D-二聚体和血小板水平升高与DVT相关。然而,生物标志物如APTT,纤维蛋白原,FDP,葡萄糖,血红蛋白,糖化血红蛋白,INR,凝血酶原时间,凝血酶原片段1.2,凝血酶-抗凝血酶复合物,WBC与PICC相关DVT的发展无关。
BACKGROUND: The measurement and identification of plasma biomarkers can support the estimation of risk and diagnosis of deep vein thrombosis (DVT) associated with the use of a peripherally inserted central catheter (PICC).
OBJECTIVE: This systematic
review and meta-analysis aimed to identify the association between the levels of potential biomarkers that reflect the activation of the blood system, long-term vascular complications, inflammatory system, and the occurrence of PICC-related DVT.
METHODS: Seven electronic databases (Embase, Web of Science, Medline, Scopus, Cinahl, Cochrane Central Register of Controlled Trials, and ERIC) were searched to identify literature published until December 2022. Studies were required to report: (I) adult and pediatric patients, outpatient or admitted to clinical, surgical, or ICU with PICC; (II) patients with PICC-related DVT and patients without PICC-related DVT as a comparator; and (III) at least one biomarker available. The Newcastle-Ottawa Scale was used to evaluate the quality of the studies. Study precision was evaluated by using a funnel plot for platelets level. We provided a narrative synthesis and meta-analysis of the findings on the biomarkers\' outcomes of the studies. We pooled the results using random effects meta-analysis. The meta-analysis was conducted using
Review Manager software v5.4. This systematic
review is registered in PROSPERO (CRD42018108871).
RESULTS: Of the 3564 studies identified (after duplication removal), 28 were included. PICC-related DVT was associated with higher D-dimers (0.37 μg/mL, 95% CI 0.02, 0.72; p = 0.04, I2 = 92%; p for heterogeneity < 0.00001) and with higher platelets (8.76 × 109/L, 95% CI 1.62, 15.91; p = 0.02, I2 = 41%; p for heterogeneity = 0.06).
CONCLUSIONS: High levels of D-dimer and platelet were associated with DVT in patients with PICC. However, biomarkers such as APTT, fibrinogen, FDP, glucose, hemoglobin, glycated hemoglobin, INR, prothrombin time, prothrombin fragment 1.2, the thrombin-antithrombin complex, and WBC were not related to the development of DVT associated with PICC.