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Sheng Y, Gao W. Machine Learning Predicts Peripherally Inserted Central Catheters-Related Deep Vein Thrombosis Using Patient Features and Catheterization Technology Features. Clin Nurs Res 2024; 33:460-469. [PMID: 39076023 DOI: 10.1177/10547738241260947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
This study aims to use patient feature and catheterization technology feature variables to train the corresponding machine learning (ML) models to predict peripherally inserted central catheters-deep vein thrombosis (PICCs-DVT) and analyze the importance of the two types of features to PICCs-DVT from the aspect of "input-output" correlation. To comprehensively and systematically summarize the variables used to describe patient features and catheterization technical features, this study combined 18 literature involving the two types of features in predicting PICCs-DVT. A total of 21 variables used to describe the two types of features were summarized, and feature values were extracted from the data of 1,065 PICCs patients from January 1, 2021 to August 31, 2022, to construct a data sample set. Then, 70% of the sample set is used for model training and hyperparameter optimization, and 30% of the sample set is used for PICCs-DVT prediction and feature importance analysis of three common ML classification models (i.e. support vector classifier [SVC], random forest [RF], and artificial neural network [ANN]). In terms of prediction performance, this study selected four metrics to evaluate the prediction performance of the model: precision (P), recall (R), accuracy (ACC), and area under the curve (AUC). In terms of feature importance analysis, this study chooses a single feature analysis method based on the "input-output" sensitivity principle-Permutation Importance. For the mean model performance, the three ML models on the test set are P = 0.92, R = 0.95, ACC = 0.88, and AUC = 0.81. Specifically, the RF model is P = 0.95, R = 0.96, ACC = 0.92, AUC = 0.86; the ANN model is P = 0.92, R = 0.95, ACC = 0.88, AUC = 0.81; the SVC model is P = 0.88, R = 0.94, ACC = 0.85, AUC = 0.77. For feature importance analysis, Catheter-to-vein rate (RF: 91.55%, ANN: 82.25%, SVC: 87.71%), Zubrod-ECOG-WHO score (RF: 66.35%, ANN: 82.25%, SVC: 44.35%), and insertion attempt (RF: 44.35%, ANN: 37.65%, SVC: 65.80%) all occupy the top three in the ML models prediction task of PICCs-DVT, showing relatively consistent ranking results. The ML models show good performance in predicting PICCs-DVT and reveal a relatively consistent ranking of feature importance from the data. The important features revealed might help clinical medical staff to better understand and analyze the formation mechanism of PICCs-DVT from a data-driven perspective.
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Affiliation(s)
- Yuan Sheng
- Shandong University, Jinan, China
- Liaocheng University, Liaocheng, China
| | - Wei Gao
- Shandong University of Qilu Hospital, Jinan, China
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Perego M, Calloni M, Taino A, Cogliati C, Gidaro A. Letter in response to a recent article by Zhang et al. []. Thromb Res 2024; 236:85-87. [PMID: 38402646 DOI: 10.1016/j.thromres.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/31/2023] [Accepted: 02/05/2024] [Indexed: 02/27/2024]
Affiliation(s)
- Martina Perego
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
| | - Maria Calloni
- Internal Medicine, L. Sacco Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Alba Taino
- Internal Medicine, L. Sacco Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Chiara Cogliati
- Internal Medicine, L. Sacco Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Antonio Gidaro
- Internal Medicine, L. Sacco Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
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Zhang J, Wu Y, Zhang S, Yao W, Bu F, Wang A, Hu X, Wang G. Appraising the quality standard of clinical practice guidelines related to central venous catheter-related thrombosis prevention: a systematic review of clinical practice guidelines. BMJ Open 2024; 14:e074854. [PMID: 38471679 PMCID: PMC10936513 DOI: 10.1136/bmjopen-2023-074854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVE To evaluate the quality and analyse the content of clinical practice guidelines regarding central venous catheter-related thrombosis (CRT) to provide evidence for formulating an evidence-based practice protocol and a risk assessment scale to prevent it. DESIGN Scoring and analysis of the guidelines using the AGREE II and AGREE REX scales. DATA SOURCES Pubmed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and the Chinese Biomedical Literature, and the relevant websites of the guideline, were searched from 1 January 2017 to 26 March 2022. ELIGIBILITY CRITERIA Guidelines covering CRT treatment, prevention, or management were included from 1 January 2017 to 26 March 2022. DATA EXTRACTION AND SYNTHESIS Three independent reviewers systematically trained in using the AGREE II and AGREE REX scales were selected to evaluate these guidelines. RESULTS Nine guidelines were included, and the quality grade results showed that three were at A-level and six were at B-level. The included guidelines mainly recommended the prevention measure of central venous CRT from three aspects: risk screening, prevention strategies, and knowledge training, with a total of 22 suggestions being recommended. CONCLUSION The overall quality of the guidelines is high, but there are few preventive measures for central venous CRT involved in the guidelines. All preventive measures have yet to be systematically integrated and evaluated, and no risk assessment scale dedicated to this field has been recommended. Therefore, developing an evidence-based practice protocol and a risk assessment scale to prevent it is urgent.
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Affiliation(s)
- Jing Zhang
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University /West China School of Nursing, Sichuan University, Chengdu, China
| | - Yongya Wu
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University /West China School of Nursing, Sichuan University, Chengdu, China
| | - Shuai Zhang
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University /West China School of Nursing, Sichuan University, Chengdu, China
| | - Wenmo Yao
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University /West China School of Nursing, Sichuan University, Chengdu, China
| | - Faqian Bu
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University /West China School of Nursing, Sichuan University, Chengdu, China
| | - Aoxue Wang
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University /West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiuying Hu
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University /West China School of Nursing, Sichuan University, Chengdu, China
| | - Guan Wang
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University /West China School of Nursing, Sichuan University, Chengdu, China
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Sheng Y, Yang LH, Wu Y, Gao W, Dongye SY. Implementation of Tunneled Peripherally Inserted Central Catheters Placement in Cancer Patients: A Randomized Multicenter Study. Clin Nurs Res 2024; 33:19-26. [PMID: 37596863 DOI: 10.1177/10547738231194099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
This study sought to evaluate the impact of the subcutaneous tunneling technique on peripherally inserted central catheter (PICC) placement. We randomized 694 patients who needed PICC placement to either the tunneled PICCs (experimental group) or the non-tunneled PICCs (control group) from August to December 2021. The cumulative frequency of complications was assessed as the primary outcome. Secondary outcomes comprised of the amount of bleeding, catheter insertion time, self-reported pain score, and one-puncture success rate. After 6 months of follow-up, the tunneled PICCs group showed a significant decrease in the frequency of total complications, especially in infection (3.0% vs. 7.1%, p = .021) and catheter-related thrombosis (3.3% vs. 8.3%, p = .008), although approximately 0.5 ml bleeding and 3.5 min time were increased. This randomized multicenter study supports the efficacy of subcutaneous tunneling technology in reducing PICC-related complications, enhancing patient comfort, and encouraging using subcutaneous tunneling technology for PICC placement.
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Affiliation(s)
- Yuan Sheng
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
- Medical School, Liaocheng University, China
| | - Li-Hong Yang
- Department of Hematology, Liaocheng People's Hospital, China
| | - Yan Wu
- Medical Oncology Center, Shandong University of Qilu Hospital, Jinan, China
| | - Wei Gao
- Department of PICCs Clinic, Shandong University of Qilu Hospital, Jinan, China
| | - Sheng-Yi Dongye
- Department of Pathology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
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Zhang X, Chen H, Jing W, Pu L, Wu Z, Su X, Chen H, Liu J, Yu H, Hu X. The clinical topography of peripherally inserted central catheter-related thrombosis in cancer patients: A prospective and longitudinal observational study based on ultrasound scans every two days. Thromb Res 2023; 229:232-242. [PMID: 37572590 DOI: 10.1016/j.thromres.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/20/2023] [Accepted: 07/28/2023] [Indexed: 08/14/2023]
Abstract
AIMS To delineate the clinical topography of peripherally inserted central catheter (PICC)-related thrombosis in cancer patients. BACKGROUND Most of the clinical features of PICC-related thrombosis are based on a single follow-up, which is insufficient to reflect the full topography of a thrombosis. DESIGN This is an observational study conducted at West China Hospital, according to the STROBE guidelines. METHODS Cancer patients scheduled for PICC placement were potentially eligible; patients with contraindications to PICC placement or existing diseases affecting blood flow were excluded; and those who later withdrew or did not reply to our contact request during the follow-up period were eliminated from this study. Ultrasound was used to detect thrombosis from the insertion site, proximal insertion site, axillary vein to the subclavian vein once every two days for two weeks post insertion. The thrombosis and its involved venous segments, onset time and symptoms and signs were recorded. RESULTS Among the 173 included patients, 126 (72.8 %) were identified as having thrombosis. Specifically, 113 and 126 patients were identified as having thrombosis within the first three days and the first week post insertion, respectively. In the 126 patients, thrombosis occurred at the insertion site (72.8 %) concurrently with thrombosis at the proximal insertion site (n = 120, 69.4 %), thrombosis in the axillary vein (n = 94, 54.3 %), and/or thrombosis in the subclavian vein (n = 41, 23.7 %). The log-rank test demonstrated that thrombosis in these four venous segments decreased significantly from the distal to the proximal central vein (log-rank test = 117.128, P < .001). Of 31 patients (17.9 %) who presented symptomatic thrombosis, only five patients experienced obvious swelling in the upper arm, and the other 26 patients exhibited atypical symptoms, such as soreness, tightness, numbness, tingling, or other discomforts in the palm, arm, armpit, and/or shoulder. In some thrombotic cases, ultrasonic assessment of PICC-related thrombosis did not parallel clinical symptoms and signs. CONCLUSION PICC-related thrombosis is common and can occur very early post insertion in cancer patients, and most thromboses present atypical symptoms. More than half of the cases with thrombosis evaluated involve multiple venous segments, and the farther the venous segments are from the central vein, the higher the incidence of thrombosis tend to be and the earlier the onset time are. RELEVANCE TO CLINICAL PRACTICE The results highlight the importance that medical staff pay particular attention to patients with catheters in the first week post insertion and be alert to thrombosis presenting atypical symptoms while keeping in mind that clinical symptoms and signs are not reliable for diagnosing thrombosis. CLINICAL REGESTRATION Clinical Trials ChiCTR1900024890.
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Affiliation(s)
- Xiaoxia Zhang
- Division of Head & Neck Tumor Multimodality Treatment, West China Hospital, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China; West China School of Nursing, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China; Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
| | - Hongxiu Chen
- West China School of Nursing, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China; Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
| | - Wenli Jing
- Department of Ultrasound, West China Hospital, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
| | - Lihui Pu
- Menzies Health Institute & School of Nursing and Midwifery, Griffith University, PO Box 4111, Griffith University, Nathan Campus, Brisbane, Queensland, Australia.
| | - Zhoupeng Wu
- Department of Vascular Surgery, West China Hospital, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
| | - Xiaotian Su
- Division of Breast Surgery, Department of General Surgery, West China Hospital, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
| | - Huirong Chen
- Division of Head & Neck Tumor Multimodality Treatment, West China Hospital, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
| | - Juan Liu
- Division of Breast Surgery, Department of General Surgery, West China Hospital, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
| | - Huaqin Yu
- Division of Head & Neck Tumor Multimodality Treatment, West China Hospital, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
| | - Xiuying Hu
- Department of Ultrasound, West China Hospital, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China
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Li J, Huang A, Han Z, Zhou Y, Tang M, Wu W, Zhang S, Liao K, Xie Y, Chen Q, Zou X, Liu S, Gao S, Ren J, Xu Q, Liu X, Liao Y, Jing T, Tan W, Qiu Y, Wang H. Postoperative intermittent pneumatic compression for preventing venous thromboembolism in Chinese lung cancer patients: a randomized clinical trial. Thromb J 2023; 21:56. [PMID: 37165434 PMCID: PMC10170726 DOI: 10.1186/s12959-023-00498-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/27/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Postoperative lung cancer patients belong to the high-risk group for venous thromboembolism (VTE). The standardized preventive measures for perioperative VTE in lung cancer are not perfect, especially for the prevention and treatment of catheter-related thrombosis (CRT) caused by carried central venous catheters (CVCs) in lung cancer surgery. PATIENTS AND METHODS This study included 460 patients with lung cancer undergoing video-assisted thoracic surgery (VATS) in our center from July 2020 to June 2021. Patients were randomized into two groups, and intraoperatively-placed CVCs would be carried to discharge. During hospitalization, the control group was treated with low-molecular-weight heparin (LMWH), and the experimental group with LMWH + intermittent pneumatic compression (IPC). Vascular ultrasound was performed at three time points which included before surgery, before discharge, and one month after discharge. The incidence of VTE between the two groups was studied by the Log-binomial regression model. RESULTS CRT occurred in 71.7% of the experimental group and 79.7% of the control group. The multivariate regression showed that the risk of developing CRT in the experimental group was lower than in the control group (Adjusted RR = 0.889 [95%CI0.799-0.989], p = 0.031), with no heterogeneity in subgroups (P for Interaction > 0.05). Moreover, the fibrinogen of patients in the experimental group was lower than control group at follow-up (P = 0.019). CONCLUSION IPC reduced the incidence of CRT during hospitalization in lung cancer patients after surgery. TRIAL REGISTRATION No. ChiCTR2000034511.
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Affiliation(s)
- Jingyao Li
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University, (Third Military Medical University), Chongqing, 400038, China
| | - Aihong Huang
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University, (Third Military Medical University), Chongqing, 400038, China
| | - Zhaojie Han
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University, (Third Military Medical University), Chongqing, 400038, China
| | - Yi Zhou
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University, (Third Military Medical University), Chongqing, 400038, China
| | - Meng Tang
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University, (Third Military Medical University), Chongqing, 400038, China
| | - Wei Wu
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University, (Third Military Medical University), Chongqing, 400038, China
| | - Shixin Zhang
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University, (Third Military Medical University), Chongqing, 400038, China
| | - Kelong Liao
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University, (Third Military Medical University), Chongqing, 400038, China
| | - Yihui Xie
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University, (Third Military Medical University), Chongqing, 400038, China
| | - Qiao Chen
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University, (Third Military Medical University), Chongqing, 400038, China
| | - Xinliang Zou
- Department of Vasculocardiology, Southwest Hospital, Army Medical University, (Third Military Medical University), Chongqing, China
| | - Shuai Liu
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University, (Third Military Medical University), Chongqing, 400038, China
| | - Shuaixiang Gao
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University, (Third Military Medical University), Chongqing, 400038, China
| | - Junlong Ren
- Department of Neck and Chest Surgery, Affiliated Hospital of Sergeant School of Army Medical University, Shijiazhuang, China
| | - Qingyuan Xu
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University, (Third Military Medical University), Chongqing, 400038, China
| | - Xi Liu
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University, (Third Military Medical University), Chongqing, 400038, China
| | - Yi Liao
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University, (Third Military Medical University), Chongqing, 400038, China
| | - Tao Jing
- Department of Vasculocardiology, Southwest Hospital, Army Medical University, (Third Military Medical University), Chongqing, China
| | - WenFeng Tan
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University, (Third Military Medical University), Chongqing, 400038, China.
| | - Yang Qiu
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University, (Third Military Medical University), Chongqing, 400038, China.
| | - Haidong Wang
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University, (Third Military Medical University), Chongqing, 400038, China.
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Development and validation of a prediction model of catheter-related thrombosis in patients with cancer undergoing chemotherapy based on ultrasonography results and clinical information. J Thromb Thrombolysis 2022; 54:480-491. [PMID: 35972592 PMCID: PMC9553810 DOI: 10.1007/s11239-022-02693-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 12/24/2022]
Abstract
Central venous catheters can be used conveniently to deliver medications and improve comfort in patients with cancer. However, they can cause major complications. The current study aimed to develop and validate an individualized nomogram for early prediction of the risk of catheter-related thrombosis (CRT) in patients with cancer receiving chemotherapy. In total, 647 patients were included in the analysis. They were randomly assigned to the training (n = 431) and validation (n = 216) cohorts. A nomogram for predicting the risk of CRT in the training cohort was developed based on logistic regression analysis results. The accuracy and discriminatory ability of the model were determined using area under the receiver operating characteristic curve (AUROC) values and calibration plots. Multivariate logistic regression analysis showed that body mass index, risk of cancer-related thrombosis, D-dimer level, and blood flow velocity were independent risk factors of CRT. The calibration plot showed an acceptable agreement between the predicted and actual probabilities of CRT. The AUROC values of the nomogram were 0.757 (95% confidence interval: 0.717-0.809) and 0.761 (95% confidence interval: 0.701-0.821) for the training and validation cohorts, respectively. Our model presents a novel, user-friendly tool for predicting the risk of CRT in patients with cancer receiving chemotherapy. Moreover, it can contribute to clinical decision-making.
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Fu J, Cai W, Zeng B, He L, Bao L, Lin Z, Lin F, Hu W, Lin L, Huang H, Zheng S, Chen L, Zhou W, Lin Y, Fu F. Development and validation of a predictive model for peripherally inserted central catheter-related thrombosis in breast cancer patients based on artificial neural network: A prospective cohort study. Int J Nurs Stud 2022; 135:104341. [DOI: 10.1016/j.ijnurstu.2022.104341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/21/2022] [Accepted: 08/02/2022] [Indexed: 10/31/2022]
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Wang Y, Cui C, Liu X, Deng L, Yang K, Li B, Xue J, Xie J, Cui W. Conditional catheter-related thrombosis free probability and risk-adapted choices of catheter for lung cancer. Thorac Cancer 2022; 13:1814-1821. [PMID: 35567315 PMCID: PMC9200883 DOI: 10.1111/1759-7714.14460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Current predictive tools assess catheter‐related thrombosis (CRT) in patients with lung cancer in a static manner at a single time point of catheterization. The subsequent hazard changes over time are unknown. The conditional catheter‐related thrombosis‐free probability (CCFP) can provide dynamic information on continual CRT‐free expectations. This study aimed to assess the CCFP and hazard rates based on risk categories and various venous access devices (VADs). Methods This retrospective study reviewed 939 patients with lung cancer with peripherally inserted central venous catheters (PICCs) or central venous catheters (CVCs) identified at the National Clinical Research Center for Cancer between January 1, 2015 and December 31, 2018. The incidence of CRT has also been reported. Patients were stratified into low‐ and high‐risk groups according to multivariate Cox regression analyses. CCFP is defined as the CRT‐free probability given that patients have no CRT for a definite time. Results A total of 507 patients with PICCs and 432 patients with CVCs were included in this study. The 3‐month CCFP increased from 74.2% at catheter insertion to 93.6% at 3 months. The hazards of CRT in the first month were highest (16.4%) and slightly thereafter. The high‐risk group initially had a higher (21.4%) but significantly decreased CRT hazard after 2 months (8.3%), whereas the low‐risk group maintained a comparable lower risk hazard of less than 5% after 1 month. In the overall cohort, patients with CVCs had lower CRT probability than those with PICCs (HR, 1.76; 95% CI: 1.28–2.41; p < 0.01). Further analysis demonstrated that compared with PICCs, CVCs provided a CRT‐free benefit in low‐risk patients (p = 0.02) but not in high‐risk patients (p = 0.06). Conclusions CCFP increased, and the hazards of CRT decreased over time in a risk‐dependent manner in patients with lung cancer. These valuable dynamic data may help optimize risk‐adjusted choices of VADs and risk‐adjusted prophylactic anticoagulation strategies for patients.
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Affiliation(s)
- Yanfeng Wang
- Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chanjuan Cui
- Department of Laboratory Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Liu
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Deng
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ke Yang
- Department of Medical Oncology, Cancer Hospital of Huanxing, Beijing, China
| | - Bin Li
- Department of Management Center, Cancer Hospital of Huanxing, Beijing, China
| | - Jie Xue
- Department of Management Center, Cancer Hospital of Huanxing, Beijing, China
| | - Junying Xie
- Department of Management Center, Cancer Hospital of Huanxing, Beijing, China
| | - Wei Cui
- Department of Laboratory Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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