Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2024; 16(7): 2221-2231
Published online Jul 27, 2024. doi: 10.4240/wjgs.v16.i7.2221
Establishment and validation of a predictive model for peripherally inserted central catheter-related thrombosis in patients with liver cancer
Xiao-Fei Chen, Hao-Jun Wu, Tang Li, Jia-Bin Liu, Wen-Jie Zhou, Qiang Guo
Xiao-Fei Chen, Jia-Bin Liu, Department of Thyroid Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Xiao-Fei Chen, Wen-Jie Zhou, The Second Department of General Surgery, Chengdu Shangjinnanfu Hospital, West China Hospital of Sichuan University, Chengdu 611730, Sichuan Province, China
Hao-Jun Wu, Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Tang Li, Department of Hepatobiliary and Pancreatic Surgery, Chengdu Shangjinnanfu Hospital, West China Hospital of Sichuan University, Chengdu 611730, Sichuan Province, China
Qiang Guo, Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Chen XF and Guo Q designed the experiments and conducted clinical data collection; Wu HJ, Li T, Liu JB and Zhou WJ performed postoperative follow-up and recorded the data; Chen XF and Guo Q conducted the collation and statistical analysis, wrote the original manuscript and revised the paper; All authors read and approved the final manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of West China Hospital of Sichuan University (No. 2023-1712).
Informed consent statement: The Ethics Committee has agreed to waive informed consent.
Conflict-of-interest statement: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data sharing statement: All data generated or analyzed during this study are included in this published article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qiang Guo, MD, Associate Professor, Department of Vascular Surgery, West China Hospital of Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu 610041, Sichuan Province, China. guoqiang6561@163.com
Received: April 30, 2024
Revised: June 3, 2024
Accepted: June 18, 2024
Published online: July 27, 2024
Processing time: 83 Days and 8.4 Hours
Abstract
BACKGROUND

Peripherally inserted central catheters (PICCs) are commonly used in hospitalized patients with liver cancer for the administration of chemotherapy, nutrition, and other medications. However, PICC-related thrombosis is a serious complication that can lead to morbidity and mortality in this patient population. Several risk factors have been identified for the development of PICC-related thrombosis, including cancer type, stage, comorbidities, and catheter characteristics. Understanding these risk factors and developing a predictive model can help healthcare providers identify high-risk patients and implement preventive measures to reduce the incidence of thrombosis.

AIM

To analyze the influencing factors of PICC-related thrombosis in hospitalized patients with liver cancer, construct a predictive model, and validate it.

METHODS

Clinical data of hospitalized patients with liver cancer admitted from January 2020 to December 2023 were collected. Thirty-five cases of PICC-related thrombosis in hospitalized patients with liver cancer were collected, and 220 patients who underwent PICC placement during the same period but did not develop PICC-related thrombosis were randomly selected as controls. A total of 255 samples were collected and used as the training set, and 77 cases were collected as the validation set in a 7:3 ratio. General patient information, case data, catheterization data, coagulation indicators, and Autar Thrombosis Risk Assessment Scale scores were analyzed. Univariate and multivariate unconditional logistic regression analyses were performed on relevant factors, and the value of combined indicators in predicting PICC-related thrombosis in hospitalized patients with liver cancer was evaluated using receiver operating characteristic (ROC) curve analysis.

RESULTS

Univariate analysis showed statistically significant differences (P < 0.05) in age, sex, Karnofsky performance status score (KPS), bedridden time, activities of daily living impairment, parenteral nutrition, catheter duration, distant metastasis, and bone marrow suppression between the thrombosis group and the non-thrombosis group. Other aspects had no statistically significant differences (P > 0.05). Multivariate regression analysis showed that age ≥ 60 years, KPS score ≤ 50 points, parenteral nutrition, stage III to IV, distant metastasis, bone marrow suppression, and activities of daily living impairment were independent risk factors for PICC-related thrombosis in hospitalized patients with liver cancer (P < 0.05). Catheter duration of 1-6 months and catheter duration > 6 months were protective factors for PICC-related thrombosis (P < 0.05). The predictive model for PICC-related thrombosis was obtained as follows: P predictive probability = [exp (Logit P)]/[1 + exp (Logit P)], where Logit P = age × 1.907 + KPS score × 2.045 + parenteral nutrition × 9.467 + catheter duration × 0.506 + tumor-node-metastasis (TNM) staging × 2.844 + distant metastasis × 2.065 + bone marrow suppression × 2.082 + activities of daily living impairment × 13.926. ROC curve analysis showed an area under the curve (AUC) of 0.827 (95%CI: 0.724-0.929, P < 0.001), with a corresponding optimal cut-off value of 0.612, sensitivity of 0.755, and specificity of 0.857. Calibration curve analysis showed good consistency between the predicted occurrence of PICC-related thrombosis and actual occurrence (P > 0.05). ROC analysis showed AUCs of 0.888 and 0.729 for the training and validation sets, respectively.

CONCLUSION

Age, KPS score, parenteral nutrition, TNM staging, distant metastasis, bone marrow suppression, and activities of daily living impairment are independent risk factors for PICC-related thrombosis in hospitalized patients with liver cancer, while catheter duration is a protective factor for the disease. The predictive model has an AUC of 0.827, indicating high predictive accuracy and clinical value.

Keywords: Liver cancer; Peripherally inserted central catheters; Thrombosis; Model; Verify

Core Tip: In this study, we comprehensively analyzed the influencing factors of peripherally inserted central catheters-related thrombosis in hospitalized patients with liver cancer. We constructed a predictive model to accurately predict the risk of thrombosis and validated its performance. Age, Karnofsky performance score, parenteral nutrition, tumor-node-metastasis staging, distant metastasis, bone marrow suppression, and activities of daily living impairment were identified as independent risk factors, while catheter duration was a protective factor. The predictive model demonstrated high accuracy, with an area under the curve of 0.827, indicating its potential clinical value in enhancing the quality of care for peripherally inserted central catheters patients with liver cancer.