Comprehensive Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, Zhejiang, China.
Department of Ultrasound, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, Zhejiang, China.
BMC Pediatr. 2024 Aug 20;24(1):534. doi: 10.1186/s12887-024-05008-2.
Catheter-related thrombosis (CRT) is a thrombotic complication associated with using central venous catheters (CVCs). Although risk factors for CRT were identified in children, no nomograms or predictive tools are available for the pediatric population with CVCs. This study aimed to develop and validate a prediction model of asymptomatic CRT in children with CVCs.
This retrospective observational study included consecutive pediatric patients who admitted to the Children's Hospital Zhejiang University School of Medicine and received CVCs between October and December 2021.
This study included 669 patients, 553 (314 males, aged 22.00 [0.36, 180.00] months, 62 with CRT) were in the training set, and 116 (62 males, aged 15.00 [1.13, 156.00] months, 16 with CRT) were in the validation set. Multivariate logistic regression showed that a catheter time of 0-3 days (OR = 0.201, 95%CI: 0.081-0.497, P = 0.001), catheter time of 4-7 days (OR = 0.412, 95%CI: 0.176-0.964, P = 0.041), male (OR = 3.976, 95%CI: 1.864-4.483, P < 0.001), congenital heart diseases (OR = 0.277, 95%CI: 0.078-0.987, P = 0.048), postoperative (OR = 0.161, 95%CI: 0.072-0.360, P < 0.001), and femoral CVC (OR = 2.451, 95%CI: 1.129-5.318, P = 0.002) were independently associated with CRT. The nomogram incorporating these variables showed relatively good discrimination (AUC = 0.77, 95%CI: [0.65, 0.90]) and calibration abilities in the validation set, and the decision curve analysis (DCA) yielded a clinical net benefit.
A prediction model for CRT in children with CVC was established based on catheter time, sex, diseases, postoperative, and catheter vein. The nomogram based on logistic regression model showed favorable predictive performance.
导管相关性血栓形成（CRT）是与使用中心静脉导管（CVC）相关的血栓并发症。尽管已经确定了儿童 CRT 的危险因素，但对于使用 CVC 的儿科人群，尚无列线图或预测工具。本研究旨在为 CVC 患儿的无症状 CRT 建立预测模型并进行验证。
本回顾性观察性研究纳入 2021 年 10 月至 12 月期间在浙江大学医学院附属儿童医院住院并接受 CVC 的连续儿科患者。
本研究共纳入 669 例患者，其中 553 例（314 例男性，年龄 22.00[0.36, 180.00] 个月，62 例发生 CRT）纳入训练集，116 例（62 例男性，年龄 15.00[1.13, 156.00] 个月，16 例发生 CRT）纳入验证集。多变量 logistic 回归显示导管留置时间 0-3 天（OR=0.201，95%CI：0.081-0.497，P=0.001）、导管留置时间 4-7 天（OR=0.412，95%CI：0.176-0.964，P=0.041）、男性（OR=3.976，95%CI：1.864-4.483，P<0.001）、先天性心脏病（OR=0.277，95%CI：0.078-0.987，P=0.048）、术后（OR=0.161，95%CI：0.072-0.360，P<0.001）和股静脉置管（OR=2.451，95%CI：1.129-5.318，P=0.002）与 CRT 独立相关。纳入这些变量的列线图在验证集中显示出较好的区分度（AUC=0.77，95%CI：[0.65, 0.90]）和校准能力，决策曲线分析（DCA）得出了临床净获益。
本研究基于导管时间、性别、疾病、术后和导管静脉建立了 CVC 患儿 CRT 的预测模型。基于 logistic 回归模型的列线图具有较好的预测性能。
