Development and Validation of a New Clinical Prediction Model of Catheter-Related Thrombosis Based on Vascular Ultrasound Diagnosis in Cancer Patients

Analyzing venous thromboembolism risk in malignant tumors: thromboelastogram and coagulation factors study

Aim: This retrospective clinical study was designed to examine the predictive value of thromboelastography (TEG) combined with coagulation function for venous thromboembolism (VTE) in hospitalized patients with cancer. Materials & methods: Among 215 patients admitted between May 2020 and January 2022, 39 (18.14%) were diagnosed with VTE during hospitalization. Results: Significant differences were found in D-dimer, ATIII and TEG parameters (maximum amplitude and coagulation index) between VTE-positive and VTE-negative patients (p < 0.05). Multivariate analysis revealed tumor node metastasis stage, concomitant infection, smoking history and D-dimer as independently associated with VTE. The constructed model and D-dimer areas under the curve were 0.809 and 0.764, respectively. Conclusion: TEG parameters were not significantly predictive indicators for VTE, with D-dimer remaining a key predictor.

Generation of a Predictive Clinical Model for Isolated Distal Deep Vein Thrombosis (ICMVT) Detection

BACKGROUND Isolated distal deep vein thrombosis (ICMVT) increases the risk of pulmonary embolism. Although predictive models are available, their utility in predicting the risk is unknown. To develop a clinical prediction model for isolated distal calf muscle venous thrombosis, data from 462 patients were used to assess the independent risk variables for ICMVT. MATERIAL AND METHODS The area under curve (AUC) for Model A and Model B were calculated and other risk factors were based on age, pitting edema in the symptomatic leg, calf swelling with least 3 cm larger than the asymptomatic leg, recent bed rest for 3 days or more in the past 4 weeks, requiring general or major surgery with regional anesthesia, sex, and local tenderness distributed along the deep venous system as independent predictors of calf muscle venous thrombosis. Model A includes the risk variables for C-reactive protein and D-dimer. RESULTS The area under ROC curve for Model A training set was 0.924 (95% CI: 0.895-0.952), the area under ROC curve for Model B training set was 0.887 (95% CI: 0.852-0.922), and the AUC difference between the 2 models was statistically significant (P<0.001); the area under ROC curve for Model A obtained in the validation set was 0.902 (95% CI: 0.844-0.961), the area under ROC curve for Model B was 0.842 (95% CI: 0. 0.773-0.910), and the difference between the 2 models was statistically significant (P=0.012). CONCLUSIONS Predictive Model A better predicts isolated calf muscle venous thrombosis and is able to help clinicians rapidly and early diagnose ICMVT, displaying higher utility for missed diagnosis prevention and disease therapy.

A 5-year experience with midline catheters in the management of major head and neck surgery patients

BACKGROUND

In the perioperative management of major head and neck surgery (HNS) patients, the performance of midline catheters (MCs) has been never tested. We present here our 5-year experience by reporting MC-related complications and by identifying the preoperative risk factors associated with their development.

METHODS

Clinical variables were extracted and the dwell time, the number, and the type of postprocedural complications of MCs were retrieved. Complications were classified into major (needing MCs removal and including catheter-related bloodstream infection or deep vein thrombosis or catheter occlusion) and into minor (accidental dislodgement, leaking, etc.). Descriptive statistics and logistic regression models were used in order to identify the predictors of complications.

RESULTS

A total of 265 patients were included, with a mean age of 67.4 years. Intraprocedural complications occurred in 1.1% of cases, while postprocedural complications occurred in 13.9% of cases (12.05/1000 days), but they were minor in more than 7.0% (5.4/1000 catheter-days). There were 19 minor complications (7.1% or 5.4/1000 catheter-days) while 18 (7%, 5.1/1000 catheter-days) patients experienced at least one major complication. Female sex (OR = 1.963, 95% CI 1.017-3.792), insertion in the right arm (OR = 2.473, 95% CI 1.150-5.318), and an ACE-27 score >1 (OR = 2.573, 95% CI 1.295-5.110) were independent predictors of major complications.

CONCLUSIONS

MCs appear to represent an effective option in the setting of major HNS. The identification of patients most at risk for MC-related complications should prompt a postoperative watchful evaluation.

Development and validation of a prediction model of catheter-related thrombosis in patients with cancer undergoing chemotherapy based on ultrasonography results and clinical information

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.

Conditional catheter-related thrombosis free probability and risk-adapted choices of catheter for lung cancer

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.