The Division of Hospital Medicine, Department of Medicine, University of MIchigan School of Medicine, Ann Arbor, MI, USA.
Patient Safety Enhancement Program and Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI, USA.
J Thromb Haemost. 2017 Oct;15(10):1951-1962. doi: 10.1111/jth.13794. Epub 2017 Sep 13.
Essentials How best to quantify thrombosis risk with peripherally inserted central catheters (PICC) is unknown. Data from a registry were used to develop the Michigan Risk Score (MRS) for PICC thrombosis. Five risk factors were associated with PICC thrombosis and used to develop a risk score. MRS was predictive of the risk of PICC thrombosis and can be useful in clinical practice.
Background Peripherally inserted central catheters (PICCs) are associated with upper extremity deep vein thrombosis (DVT). We developed a score to predict risk of PICC-related thrombosis. Methods Using data from the Michigan Hospital Medicine Safety Consortium, image-confirmed upper-extremity DVT cases were identified. A logistic, mixed-effects model with hospital-specific random intercepts was used to identify factors associated with PICC-DVT. Points were assigned to each predictor, stratifying patients into four classes of risk. Internal validation was performed by bootstrapping with assessment of calibration and discrimination of the model. Results Of 23 010 patients who received PICCs, 475 (2.1%) developed symptomatic PICC-DVT. Risk factors associated with PICC-DVT included: history of DVT; multi-lumen PICC; active cancer; presence of another CVC when the PICC was placed; and white blood cell count greater than 12 000. Four risk classes were created based on thrombosis risk. Thrombosis rates were 0.9% for class I, 1.6% for class II, 2.7% for class III and 4.7% for class IV, with marginal predicted probabilities of 0.9% (0.7, 1.2), 1.5% (1.2, 1.9), 2.6% (2.2, 3.0) and 4.5% (3.7, 5.4) for classes I, II, III, and IV, respectively. The risk classification rule was strongly associated with PICC-DVT, with odds ratios of 1.68 (95% CI, 1.19, 2.37), 2.90 (95% CI, 2.09, 4.01) and 5.20 (95% CI, 3.65, 7.42) for risk classes II, III and IV vs. risk class I, respectively. Conclusion The Michigan PICC-DVT Risk Score offers a novel way to estimate risk of DVT associated with PICCs and can help inform appropriateness of PICC insertion.
外周置入中心静脉导管（PICC）相关血栓形成的最佳血栓风险量化方法尚不清楚。本研究使用登记处的数据制定了密歇根州 PICC 血栓形成风险评分（MRS）。
使用密歇根医院医学安全联合会的数据，确定经影像学证实的上肢深静脉血栓形成（DVT）病例。采用具有医院特定随机截距的逻辑、混合效应模型，确定与 PICC-DVT 相关的因素。为每个预测因子分配分数，将患者分层为四个风险类别。通过bootstrap 进行内部验证，并评估模型的校准和区分能力。
在接受 PICC 的 23010 名患者中，475 名（2.1%）发生症状性 PICC-DVT。与 PICC-DVT 相关的危险因素包括：DVT 病史；多腔 PICC；活动性癌症；放置 PICC 时存在另一个中央导管；白细胞计数大于 12000。根据血栓形成风险创建了四个风险类别。I 类的血栓形成率为 0.9%，II 类为 1.6%，III 类为 2.7%，IV 类为 4.7%，预测概率分别为 0.9%（0.7，1.2）、1.5%（1.2，1.9）、2.6%（2.2，3.0）和 4.5%（3.7，5.4）。风险分类规则与 PICC-DVT 密切相关，II、III 和 IV 类的优势比分别为 1.68（95%CI，1.19，2.37）、2.90（95%CI，2.09，4.01）和 5.20（95%CI，3.65，7.42）。
密歇根州 PICC-DVT 风险评分提供了一种估计与 PICC 相关的 DVT 风险的新方法，有助于判断 PICC 插入的适宜性。
