Tian Lingyun, Li Wan, Su Yanan, Gao Huimin, Yang Qiuhong, Lin Pan, Wang Liqian, Zeng Jiaqi, Li Yinglan
Xiangya Nursing School, Central South University, Changsha, China.
School of Nursing, Anhui University of Chinese Medicine, Hefei, China.
Thromb Haemost. 2021 May;121(5):625-640. doi: 10.1055/s-0040-1720976. Epub 2020 Nov 13.
To identify the potential associations of patient-, treatment-, and central venous access device (CVAD)-related factors with the CVAD-related thrombosis (CRT) risk in hospitalized children.
A systematic search of PubMed, EMBASE, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, Wanfang, and VIP database was conducted. RevMan 5.3 and Stata 12.0 statistical software were employed for data analysis.
In terms of patient-related factors, the patient history of thrombosis (odds ratio [OR] = 3.88, 95% confidence interval [CI]: 2.57-5.85), gastrointestinal/liver disease (OR = 1.85, 95% CI: 0.99-3.46), hematologic disease (OR = 1.45, 95% CI: 1.06-1.99), and cancer (OR = 1.58, 95% CI: 1.01-2.48) were correlated with an increased risk of CRT. In terms of treatment-related factors, parenteral nutrition (PN)/total PN (OR = 1.70, 95% CI: 1.21-2.39), hemodialysis (OR = 2.17, 95% CI: 1.34-3.51), extracorporeal membrane oxygenation (OR = 1.51, 95% CI: 1.31-1.71), and cardiac catheterization (OR = 3.92, 95% CI: 1.06-14.44) were associated with an increased CRT risk, while antibiotics (OR = 0.46, 95% CI: 0.32-0.68) was associated with a reduced CRT risk. In terms of the CVAD-related factors, CRT risk was more significantly increased by peripherally inserted central catheter than tunneled lines (OR = 1.81, 95% CI: 1.15-2.85) or totally implantable venous access port (OR = 2.81, 95% CI: 1.41-5.60). And subclavian vein catheterization significantly contributed to a lower CRT risk than femoral vein catheterization (OR = 0.36, 95% CI: 0.14-0.88). Besides, multiple catheter lines (OR = 4.06, 95% CI: 3.01-5.47), multiple catheter lumens (OR = 3.71, 95% CI: 1.99-6.92), central line-associated bloodstream infection (OR = 2.66, 95% CI: 1.15-6.16), and catheter malfunction (OR = 1.65, 95% CI: 1.07-2.54) were associated with an increased CRT risk.
The exact identification of the effect of risk factors can boost the development of risk assessment tools with stratifying risks.
确定患者、治疗及中心静脉通路装置（CVAD）相关因素与住院儿童CVAD相关血栓形成（CRT）风险之间的潜在关联。
对PubMed、EMBASE、Web of Science、Cochrane图书馆、中国知网、万方和维普数据库进行系统检索。采用RevMan 5.3和Stata 12.0统计软件进行数据分析。
在患者相关因素方面，血栓形成病史（比值比[OR]=3.88，95%置信区间[CI]：2.57 - 5.85）、胃肠道/肝脏疾病（OR = 1.85，95% CI：0.99 - 3.46）、血液系统疾病（OR = 1.45，95% CI：1.06 - 1.99）和癌症（OR = 1.58，95% CI：1.01 - 2.48）与CRT风险增加相关。在治疗相关因素方面，肠外营养（PN）/全肠外营养（OR = 1.70，95% CI：1.21 - 2.39）、血液透析（OR = 2.17，95% CI：1.34 - 3.51）、体外膜肺氧合（OR = 1.51，95% CI：1.31 - 1.71）和心导管插入术（OR = 3.92，95% CI：1.06 - 14.44）与CRT风险增加相关，而抗生素（OR = 0.46，95% CI：0.32 - 0.68）与CRT风险降低相关。在CVAD相关因素方面，外周静脉穿刺中心静脉置管比隧道式导管（OR = 1.81，95% CI：1.15 - 2.85）或完全植入式静脉通路装置（OR = 2.81，95% CI：1.41 - 5.60）更显著增加CRT风险。并且锁骨下静脉置管比股静脉置管显著降低CRT风险（OR = 0.36，95% CI：0.14 - 0.88）。此外，多根导管（OR = 4.06，95% CI：3.01 - 5.47）、多个导管腔（OR = 3.71，95% CI：1.99 - 6.92）、中心静脉导管相关血流感染（OR = 2.66，95% CI：1.15 - 6.16）和导管故障（OR = 1.65，95% CI：1.07 - 2.54）与CRT风险增加相关。
准确识别危险因素的影响可促进具有风险分层功能的风险评估工具的开发。
