Liu Wanli, He Lianxiang, Zeng Wenjing, Yue Liqing, Wei Jie, Zeng Shuangshuang, Wang Xiang, Gong Zhicheng
Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
Thromb J. 2021 Apr 9;19(1):24. doi: 10.1186/s12959-021-00275-w.
The purpose of this study is to elucidate the association between peripherally inserted central venous catheter (PICC) in upper extremities and lower extremity deep venous thrombosis (LEDVT) by observing the changes in D-dimer.
This was a retrospective cohort study with 3452 patients (104 inserted with PICCs and 3348 without PICC) enrolled at the neurology department from April 1, 2017 to April 1, 2020. The patients underwent color Doppler ultrasound (CDU) and D-dimer examinations. LEDVT-related factors and D-dimer value were analyzed before and after PICC insertion. The predictive value of D-dimer for LEDVT was also evaluated.
Univariate logistic regression analysis showed that PICC insertion increased the risk of LEDVT by 9 times and promoted the increase of D-dimer by 5 times. After risk adjustment, multivariate logistic regression analysis showed that PICC insertion increased the risk of LEDVT by 4 times and tripled the risk of D-dimer increase. The concentration of D-dimer was significantly increased after PICC insertion. D-dimer was unsuitable for excluding venous thrombosis in patients inserted with PICCs.
PICC insertion increases the level of D-dimer and the risk of LEDVT. The risks of venous thrombosis need to be assessed in patients inserted with PICCs to ensure the expected clinical outcomes.
本研究旨在通过观察D-二聚体的变化，阐明上肢经外周静脉穿刺中心静脉置管（PICC）与下肢深静脉血栓形成（LEDVT）之间的关联。
这是一项回顾性队列研究，纳入了2017年4月1日至2020年4月1日在神经内科就诊的3452例患者（104例接受了PICC置管，3348例未接受PICC置管）。患者接受了彩色多普勒超声（CDU）和D-二聚体检查。分析了PICC置管前后与LEDVT相关的因素及D-二聚体值。还评估了D-二聚体对LEDVT的预测价值。
单因素logistic回归分析显示，PICC置管使LEDVT风险增加9倍，使D-二聚体升高幅度增加5倍。风险调整后，多因素logistic回归分析显示，PICC置管使LEDVT风险增加4倍，使D-二聚体升高风险增加两倍。PICC置管后D-二聚体浓度显著升高。D-二聚体不适用于排除接受PICC置管患者的静脉血栓形成。
PICC置管会增加D-二聚体水平及LEDVT风险。对于接受PICC置管的患者，需要评估静脉血栓形成的风险，以确保获得预期的临床结局。
