Aitken Emma, Honour Patrick, Johnson Natalie, Kingsmore David
1 Department of Renal Surgery, Western Infirmary, Glasgow, Scotland - UK.
J Vasc Access. 2015;16 Suppl 9:S42-7. doi: 10.5301/jva.5000335. Epub 2015 Mar 8.
Central vein stenosis (CVS) and line infection are well-recognized complications of tunnelled central venous catheters (TCVCs) in patients on haemodialysis. The aim of this study was to evaluate any relationship between CVS and line infection.
Analysis of 500 consecutive patients undergoing TCVC insertion was undertaken. Data were collected on patient demographics, details of line insertion and duration, culture-proven bacteraemia and presence of symptomatic CVS. Logistic regression analysis was used to determine risk factors for CVS and bacteraemia.
Mean patient age was 59.0 years (range: 17-93). Mean number of catheter days was 961.1 ± 57.6 per TCVC; 39.4% of TCVCs were associated with culture-proven bacteraemia and 23.6% developed symptomatic CVS. Bacteraemia and CVS were inevitable complications of all TCVCs. The time to symptomatic CVS was longer in patients with bacteraemia than without (1230.91 ± 101.29 vs. 677.49 ± 61.59 days, p<0.001). Patients who had early infection within 90 days of TCVC insertion were less likely to develop CVS (5.9% vs. 22.8%, p<0.001). There was no difference in the bacteraemia rate per 1,000 catheter days between patients with and without CVS (2.62 ± 1.41 vs. 2.35 ± 0.51; p = 0.98). Number of line days (odds ratio (OR) 1.02, p = 0.003), age (OR 1.04, p = 0.04) and culture-proven line infection (OR 0.59, p = 0.014) were all independently associated with CVS.
Our results suggest that early line infection may be protective against CVS. Alternatively, there may be two distinct predisposition states for CVS and line infection. Further studies are needed to confirm our association and investigate causation.
中心静脉狭窄（CVS）和导管相关感染是血液透析患者带隧道中心静脉导管（TCVC）常见的并发症。本研究旨在评估CVS与导管相关感染之间的关系。
对500例连续接受TCVC置入的患者进行分析。收集患者人口统计学资料、导管置入细节及持续时间、经培养证实的菌血症以及有症状CVS的情况。采用逻辑回归分析确定CVS和菌血症的危险因素。
患者平均年龄为59.0岁（范围：17 - 93岁）。每根TCVC的平均导管留置天数为961.1±57.6天；39.4%的TCVC与经培养证实的菌血症相关，23.6%出现有症状的CVS。菌血症和CVS是所有TCVC不可避免的并发症。有菌血症的患者出现有症状CVS的时间比无菌血症的患者更长（1230.91±101.29天对677.49±61.59天，p<0.001）。在TCVC置入后90天内发生早期感染的患者发生CVS的可能性较小（5.9%对22.8%，p<0.001）。有无CVS的患者每1000导管日的菌血症发生率无差异（2.62±1.41对2.35±0.51；p = 0.98）。导管留置天数（比值比（OR）1.02，p = 0.003）、年龄（OR 1.04，p = 0.04）和经培养证实的导管相关感染（OR 0.59，p = 0.014）均与CVS独立相关。
我们的结果表明早期导管相关感染可能对CVS有保护作用。或者，CVS和导管相关感染可能存在两种不同的易患状态。需要进一步研究来证实我们的关联并探究因果关系。
