成人癌症患者中心静脉置管相关血栓形成的发生率及危险因素。
Catheter-related thrombosis incidence and risk factors in adult cancer patients with central venous access devices.
机构信息
Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
出版信息
Intern Med J. 2020 Dec;50(12):1475-1482. doi: 10.1111/imj.14780.
BACKGROUND
Central venous access devices (CVAD) are commonly employed in the management of cancer patients. While having several benefits they are associated with significant risks.
AIM
To review the incidence and risk factors for catheter-related thrombosis (CRT) in cancer patients with a CVAD.
METHODS
We performed a prospective observational cohort study of adult patients with cancer requiring a CVAD between 1 January 2004 and 29 June 2016. The rate of, and risk factors for the development of, symptomatic CRT were evaluated.
RESULTS
A total of 4920 central lines was inserted into 3130 patients. The incidence of CRT was 3.6%. CRT developed a median of 12 days following line insertion. Peripherally inserted central catheters (PICC) were associated with the highest rates of CRT (hazards ratio (HR) 22.2, 95% confidence interval (CI) 2.9-170.6). Older age groups developed CRT at lower rates (HR 0.57; 95% CI 0.39-0.84 for age 50-61 years, and HR 0.63; 95% CI 0.45-0.89 for age >61 years) compared to age <50 years. Increased CRT was seen in patients with prior CRT (HR 1.81; 95% CI 1.19-2.77). There was a trend to more CRT events with a Khorana tumour score of 1 compared to those with a score of 0 (HR 1.37, 95% CI 1.00-1.88). Hodgkin lymphoma, germ cell and oesophagus cancers had the highest CRT rates. Side of insertion was not associated with thrombosis risk (HR 0.77; 95% CI 0.57-1.05; P = 0.10).
CONCLUSIONS
Age <50 years, PICC lines and prior CRT were associated with highest CRT rate. Cancer subtype and insertion side were not predictive of thrombosis.
背景
中央静脉置管（CVAD）常用于癌症患者的治疗。虽然有许多好处，但它们也伴随着显著的风险。
目的
回顾癌症患者使用 CVAD 时导管相关性血栓形成（CRT）的发生率和危险因素。
方法
我们对 2004 年 1 月 1 日至 2016 年 6 月 29 日期间需要 CVAD 的成年癌症患者进行了前瞻性观察队列研究。评估了症状性 CRT 的发生和危险因素。
结果
共插入 3130 名患者的 4920 条中央导管。CRT 的发生率为 3.6%。CRT 在置管后中位 12 天发生。外周插入中心静脉导管（PICC）与 CRT 发生率最高（风险比（HR）22.2，95%置信区间（CI）2.9-170.6）。年龄较大的患者 CRT 发生率较低（HR 0.57；95%CI 50-61 岁年龄组为 0.39-0.84，年龄 >61 岁年龄组为 0.63；95%CI 0.45-0.89）与 <50 岁相比。有 CRT 病史的患者 CRT 发生率增加（HR 1.81；95%CI 1.19-2.77）。Khorana 肿瘤评分 1 分的患者比 0 分的患者 CRT 事件更多（HR 1.37，95%CI 1.00-1.88）。霍奇金淋巴瘤、生殖细胞癌和食道癌的 CRT 发生率最高。置管侧与血栓形成风险无关（HR 0.77；95%CI 0.57-1.05；P=0.10）。
结论
年龄 <50 岁、PICC 导管和 CRT 病史与 CRT 发生率最高相关。癌症亚型和置管侧不能预测血栓形成。
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