From the Vanderbilt University School of Medicine, 2209 Garland Ave, Nashville, TN 37240 (A.W.P., J.M.W.); and Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (D.B.B., F.B.).
Radiology. 2019 May;291(2):513-518. doi: 10.1148/radiol.2019182175. Epub 2019 Feb 12.
Background Patients who require long-term central venous access can present for port placement with depressed immune function as a result of their treatment or disease process. At present, there is no consensus regarding whether neutropenia at the time of port placement confers a higher risk for early infection-related port removal. Purpose To compare the incidence of early infection-related chest port removal in adults when placed in neutropenic versus nonneutropenic patient groups. Materials and Methods This retrospective cohort study examined 2580 port placements in 1081 men (41.9%) and 1499 women (58.1%) at a single tertiary medical center between June 2007 and July 2017. Mean patient age ± standard deviation was 56 years ± 14 (range, 18-91 years). The electronic medical record was used to identify neutropenia (absolute neutrophil count <1500 cells/mm) at the time of port placement and incidence of infection-related port removal. Electronic medical record follow-up was conducted for 30 days following port placement. End points were infection-related port removal or death related to port infection within 30 days. Statistical analysis compared the neutropenic ( = 159) and nonneutropenic ( = 2421) patient groups by using a χ test for categorical data and a Student test for continuous variables, with a Fisher exact test to compare incidence of port removal and death related to port infection. Results Ports placed in patients with neutropenia had an infection-related removal rate of 3.8% (six of 159) versus 0.91% (22 of 2421) in patients without neutropenia ( = .003). Patients with neutropenia had a port infection-related death rate of 0.63% (one of 159) versus 0.12% (three of 2421) for patients without neutropenia ( = .22). Conclusion Neutropenia in adults at the time of implantable subcutaneous chest port placement was associated with a higher risk for early infection-related port removal. There was no difference in the incidence of death related to port infection in neutropenic or nonneutropenic populations. © RSNA, 2019 See also the editorial by Johnson in this issue.
由于治疗或疾病过程，需要长期中心静脉通路的患者可能会出现免疫功能低下。目前，对于在置管时中性粒细胞减少的患者，其早期与感染相关的端口移除风险是否更高，尚无共识。目的：比较中性粒细胞减少症与非中性粒细胞减少症患者群体中，早期与感染相关的胸端口移除的发生率。材料与方法：本回顾性队列研究分析了 2007 年 6 月至 2017 年 7 月期间，在一家三级医疗中心进行的 2580 例 1081 名男性（41.9%）和 1499 名女性（58.1%）的端口放置情况。患者的平均年龄±标准差为 56 岁±14 岁（范围，18-91 岁）。使用电子病历识别置管时的中性粒细胞减少症（绝对中性粒细胞计数<1500 个/毫米）和与感染相关的端口移除的发生率。对端口放置后 30 天进行电子病历随访。终点是 30 天内与感染相关的端口移除或与端口感染相关的死亡。采用卡方检验比较分类数据，采用学生 t 检验比较连续变量，采用 Fisher 确切检验比较端口移除和与端口感染相关的死亡的发生率，对中性粒细胞减少症（=159）和非中性粒细胞减少症（=2421）患者组进行比较。结果：中性粒细胞减少症患者的端口与感染相关的移除率为 3.8%（159 例中的 6 例），而非中性粒细胞减少症患者的端口与感染相关的移除率为 0.91%（2421 例中的 22 例）（=0.003）。中性粒细胞减少症患者的端口感染相关死亡率为 0.63%（159 例中的 1 例），而非中性粒细胞减少症患者的端口感染相关死亡率为 0.12%（2421 例中的 3 例）（=0.22）。结论：在植入式皮下胸部端口放置时，成年人的中性粒细胞减少症与早期与感染相关的端口移除风险增加相关。在中性粒细胞减少症或非中性粒细胞减少症患者中，与端口感染相关的死亡发生率没有差异。
