摘要
目的:基于Meta分析构建住院成年癌症病人经外周置入中心静脉导管(PICC)相关性静脉血栓风险预测模型,并基于回顾性临床数据对预测模型进行验证。方法:系统检索PubMed、EMbase、the Cochrane Library、中国知网(CNKI)、万方数据库、维普数据库和中国生物医学文献数据库(CBM)建库至2022年12月收录的有关住院成年癌症病人PICC相关性静脉血栓危险因素的原始研究,检索最后更新时间为2023年12月。采用STATA 14.0对纳入研究的数据进行Meta分析,明确住院成年癌症病人PICC相关性静脉血栓的独立危险因素,并对各独立危险因素的合并效应值进行β值转换,构建住院成年癌症病人PICC相关性静脉血栓风险预测模型。收集2020年1月—2021年12月在重庆大学附属肿瘤医院接受PICC置管的905例癌症病人的临床资料,绘制预测模型预测PICC相关性静脉血栓形成的受试者工作特征(ROC)曲线,验证预测模型。结果:共纳入16篇文献,涵盖32个危险因素,经Meta分析证实其中13个危险因素与PICC相关性静脉血栓具有相关性。通过换算公式得到预测模型Logit(P)=-2.336+0.978×肿瘤转移+1.613×TPN输注+0.940×年龄+1.157×肿瘤分期+1.411×置入静脉+1.157×导管尖端位置+0.802×APTT水平+1.416×D-二聚体+1.340×病理类型+0.854×糖尿病+1.169×血栓史+1.154×置管期间化疗史+0.285×高脂血症。将905例住院成年癌症病人的临床数据代入预测模型进行外部验证,敏感度为67.7%,特异度为60.4%,约登指数为0.281,ROC曲线下面积(AUC)为0.638。结论:本研究基于Meta分析构建了包含13个独立危险因素的住院成年癌症病人PICC相关性静脉血栓风险预测模型。模型预测效果较好,表明基于证据整合策略构建的住院成年癌症病人PICC相关性静脉血栓风险预测模型具有良好的外推性、科学性和实用性。
Objective:To construct and validate a risk predictive model for peripheral inserted central catheter(PICC)-related venous thrombosis in adult cancer patients based on Meta-analysis and retrospective clinical data.Methods:A systematic literature search was performed in PubMed,EMbase,the Cochrane Library,CNKI,WanFang Database,VIP,and CBM for identifying researches focusing PICC related venous thrombotic risk factors in adult cancer patients published through December 2022,with the latest update in December 2023.Meta-analysis was performed using STATA 14.0 to identify independent risk factors for PICC related venous thrombosis in adult cancer patients,then the effect of each independent risk factor on the development of PICC-related venous thrombosis was determined usingβ-formation conversion for developing the risk predictive model.Finally,we collected the clinical data of 905 adult cancer patients who underwent PICC catheterization at Chongqing University Cancer Hospital between January 2020 and December 2021 to evaluate the predictive performance of the risk predictive model by drawing the receiver of curve(ROC).Results:A total of 16 articles covering 32 risk factors were included for the final data analysis.Meta-analysis confirmed that 13 of these risk factors were significantly associated with the development of the PICC-related venous thrombosis.We constructed the prediction model as follow:Logit(P)=-2.336+0.978×tumor metastasis+1.613×TPN infusion+0.940×age+1.157×tumor stage+1.411×catheterized vein+1.157×catheter tip position+0.802×APTT level+1.416×D-dimer+1.340×pathological type+0.854×diabetes+1.169×thrombotic history+1.154×chemotherapy history during catheterization+0.285×hyperlipidemia.The clinical data of 905 patients were imported into the prediction model for external validation,obtaining a sensitivity of 67.7%,specificity of 60.4%,Youden index of 0.281,and area under the ROC curve(AUC)of 0.638.Conclusion:This study constructs a risk prediction model for PICC-related venous thrombosis based
作者
刘晓玲
陈慧
LIU Xiaoling;CHEN Hui(Chongqing University Cancer Hospital,Chongqing 400030 China)
出处
《循证护理》
2024年第15期2681-2688,共8页
Chinese Evidence-Based Nursing
基金
重庆市科卫联合医学科研项目,编号:2019MSXM058。
