开发一种风险评分模型，以预测活动期癌症患者经外周静脉穿刺中心静脉置管（PICC）后发生血栓的风险。
Development of a risk score to predict peripherally inserted central catheter thrombosis in active cancer.
机构信息
Monash Haematology, Monash Health, Melbourne, Victoria, Australia.
Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia.
出版信息
Intern Med J. 2022 Oct;52(10):1733-1740. doi: 10.1111/imj.15557. Epub 2022 Aug 9.
BACKGROUND
Peripherally inserted central catheter (PICC) thrombosis is common.
AIMS
To explore the prevalence of symptomatic PICC thrombosis and pulmonary embolism (PE)/deep vein thrombosis (DVT) in cancer and non-cancer cohorts. In active cancer, we assessed the Khorana risk score (KRS) and Michigan risk score (MRS) for predicting PICC thrombosis and modifications to improve discriminative accuracy.
METHODS
We reviewed consecutive cancer patients receiving chemotherapy through a PICC inserted April 2017 to July 2018. For each case, we identified a contemporaneous non-cancer control.
RESULTS
Among 147 cancer patients, median age 64 years, PICC duration 70 days (range, 2-452), 7% developed PICC thrombosis (95% confidence interval (CI) 3.6-12.2) and 4% (95% CI 2-9) PE/DVT. Among 147 controls, median age 68 years, PICC duration 18.3 days (range, 0.5-210), 0.7% (95% CI 0-4) developed PICC thrombosis and 2% (95% CI 0.4-6) PE/DVT. In our cancer cohort, no KRS < 1 patients developed PICC thrombosis (95% CI 0-11) compared with 9% (95% CI 5-16) in KRS ≥ 1 (P = 0.12). PICC thrombosis occurred in 4.7% (95% CI 1.5-11.7) MRS ≤ 3 compared with 10.9% (95% CI 4.1-22.2) MRS > 3 (P = 0.32). The addition of thrombocytosis, a variable from KRS, to MRS (modified MRS (mMRS)) improved discriminative value for PICC thrombosis (c-statistic MRS 0.63 (95% CI 0.44-0.82), mMRS 0.72 (95% CI 0.58-0.85)). PICC thrombosis occurred in 1.4% (95% CI 0-8.3) mMRS ≤ 3 and 11.8% (95% CI 6.1-21.2) mMRS > 3 (P = 0.02). More patients were categorised as low risk using mMRS ≤ 3 (47%) than KRS < 1 (22%).
CONCLUSION
Cancer patients had longer PICC durations and higher PICC thrombosis rates than those without (7% vs 0.7%). mMRS more accurately classified low PICC thrombosis risk than KRS <1(47% vs 22%). Prospective validation of mMRS is warranted.
背景
外周置入中心静脉导管（PICC）血栓形成较为常见。
目的
探讨癌症和非癌症患者中症状性 PICC 血栓形成和肺栓塞（PE）/深静脉血栓形成（DVT）的发生率。在活动性癌症中，我们评估了 Khorana 风险评分（KRS）和密歇根风险评分（MRS）预测 PICC 血栓形成的能力，并对其进行了改良以提高判别准确性。
方法
我们回顾性分析了 2017 年 4 月至 2018 年 7 月期间通过 PICC 接受化疗的连续癌症患者。对于每个病例，我们都确定了一名同期的非癌症对照。
结果
在 147 例癌症患者中，中位年龄 64 岁，PICC 留置时间 70 天（范围，2-452 天），7%（95%置信区间 3.6-12.2）发生 PICC 血栓形成，4%（95%置信区间 2-9）发生 PE/DVT。在 147 例对照中，中位年龄 68 岁，PICC 留置时间 18.3 天（范围，0.5-210 天），0.7%（95%置信区间 0-4）发生 PICC 血栓形成，2%（95%置信区间 0.4-6）发生 PE/DVT。在我们的癌症队列中，没有 KRS < 1 的患者发生 PICC 血栓形成（95%CI 0-11），而 KRS ≥ 1 的患者为 9%（95%CI 5-16）（P = 0.12）。MRS ≤ 3 的患者中有 4.7%（95%CI 1.5-11.7）发生 PICC 血栓形成，而 MRS > 3 的患者有 10.9%（95%CI 4.1-22.2）（P = 0.32）。将血小板增多症（KRS 中的一个变量）加入到 MRS 中（改良 MRS（mMRS）），提高了对 PICC 血栓形成的判别价值（MRS 的 C 统计量为 0.63（95%CI 0.44-0.82），mMRS 为 0.72（95%CI 0.58-0.85））。mMRS ≤ 3 的患者中有 1.4%（95%CI 0-8.3）发生 PICC 血栓形成，而 mMRS > 3 的患者有 11.8%（95%CI 6.1-21.2）（P = 0.02）。使用 mMRS ≤ 3 分类为低风险的患者比例（47%）高于 KRS < 1（22%）。
结论
癌症患者的 PICC 留置时间较长，PICC 血栓形成率高于非癌症患者（7% vs 0.7%）。mMRS 比 KRS < 1 更准确地分类低 PICC 血栓形成风险（47% vs 22%）。需要前瞻性验证 mMRS。
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