Construction Of Risk Assessment Rule Of PICC Related Thrombosis In Cancer Patients

ObjectiveTo explore the risk factors ofperipherally inserted central catheter related thrombosis(PICC-CRT)by a prospective survey of cancer patients with PICC,and a risk assessment rule of PICC-CRT will be established,in order to provide reference for the prediction of PICC-CRT and development of PICC-CRT prevention measures in cancer patients.Method1.This study used convenient sampling method.According to the inclusion and exclusion criteria,307 cases of cancer patients with PICC were selected.In chronological order,all samples were divided into model group and evaluation group,andmodel group including 207 cases,evaluation group including 100 cases.Model group were collected general information,medical history,puncture process and other information when PICC was punctured.Patients' clinical treatment and catheter related complications were collected when they returned to hospital for chemotherapy.Blood vessel ultrasound was performed until thrombosis or catheter was removed,the follow up was completed,and at the same time,blood indicators were collected again during the chemotherapy.2.Single factor analysis and multivariate logistic regression analysis were carried out to select the independent risk factors of PICC-CRT.The risk factors were assigned to the corresponding score,and the PICC-CRT risk assessment rule was constructedpreliminarily.3.The risk assessment rule of this study and Scoring System for Instrument for Predicting Upper Extremity DVT During Hospital Stay(referred to as Seeley scale)were applied to evaluation samples.The risk assessment rule was completed and was evaluated prediction power with receiver operating characteristic curve(ROC curve).Two rules with thearea under the curve was compared,risking prediction power and PICC-CRT diagnostic accuracy was evaluated.Results1.307 samples in this study,a total of 81 cases of thrombosis(model group of 54 cases,evaluation group of 27 cases),the totalincidence ofPICC-CRT was 26.38%.The incidence of symptomatic thrombosis was 24.69% in 81 patients,and the incidence of asymptomatic thrombosis was75.30%?2.Univariate analysis demonstrated that PICC-CRT was statistically significant with the history of chemotherapy,using chemotherapeutic drugs that direct damage deoxyribonucleic acid,times of chemotherapy,prolapse of catheter,catheter indwelling time?1 month,D-dimer increased before catheter,total cholesterolincreased before catheter,apolipoprotein B increased before catheter,apolipoprotein AI decreased before catheter,WBC count increased in the last chemotherapy,fibrinogen increased in the last chemotherapy and D-dimer increased in the last chemotherapy(P<0.10).3.Multiariable Logistic regression analysis show that prolapse of catheter,catheter indwelling time?1 month,D-dimer rises before catheter,total cholesterol rise before catheter,WBC count increased in the last chemotherapy and fibrinogen increased in the last chemotherapy wereindependent risk factors of PICC-CRT.4.The independent risk factors of PICC-CRT were assigned score: catheter indwelling time?1 months(2 points),White Blood Cell count increased in the last chemotherapy(2 points),prolapse of catheter,(1 point),D-dimer rise before catheter(1 point),total cholesterol rise before catheter(1 point),fibrinogen increased in the last chemotherapy(1 point).PICC-CRT risk assessment rule was constructed preliminarily.5.ROC curve analysis: the cutoff point was1 point,the risk assessment rule evaluation criteria was determined.when total score more than 1,the risk of PICC-CRT is high,when total score is or less 1,the risk of PICC-CRT is low,at the same time,the risk assessment rule was completed.Its sensitivity was 62.96%,specificity was 89.04%,and the area under the curve(AUC)was 0.834.The AUC of the rule in this study was comparedwithSeeley scale,and the difference was statistically significant(P<0.05).Conclusion1.The incidence of PICC-CRT in cancer patients is high,and most patients have no obvious clinical symptoms,and their prevention and treatment should be widely regarded.2.Prolapse of catheter,catheter indwelling time?1 month,D-dimer increased before catheter,total cholesterol increased before catheter,White Blood Cell count increased in the last chemotherapy and fibrinogen increased in the last chemotherapy areindependent risk factors of PICC-CRT.3.The risk assessment rule of PICC-CRT is simple,easy to operate,and has certain accuracy for the forecast of PICC-CRT,which can be used to assess the risk of CRT in cancer patients?Although ithas a certain clinical significance,its poor sensitivity,still need to further improve.