Establishment Of Risk Assessment Model For PICC-related Upper Extremity Venous Thrombosis In Patients With Breast Cancer Chemotherapy

Objective:1.To investigate the independent risk factors of PICC related upper extremity venous thrombosis(PICC related to upper extremity venous thrombosis PRUEVT)in patients with breast cancer chemotherapy.2.The risk assessment model of PRUEVT in patients with breast cancer chemotherapy was constructed,the high risk population of PRUEVT in patients with breast cancer chemotherapy was screened out,and the predictive ability of the model was verified,which provided a new PRUEVT risk assessment tool for clinic.3.The newly PICC-associated thrombus risk assessment tool developed by Professor Vineet Chopra of the University of Michigan School of Medicine in the United States is introduced to provide reference for clinical practice.Methods:1.This study was based on Caprini scale,Padua scale,Autar scale and translated Michigan thrombus risk assessment model,combined with the clinical characteristics of breast cancer chemotherapy patients.A questionnaire was developed to investigate the risk factors of PICC-associated upper limb venous thrombosis in patients with breast cancer chemotherapy.From January 2017 to June 2018,patients with breast cancer were treated with PICC catheterization for breast cancer chemotherapy in the Department of Oncology,a third grade A hospital in Bengbu City.The laboratory examination results of breast cancer chemotherapy patients one week before PICC catheterization,the relevant information of ultrasound guided catheterization,and the information from catheterization to extubation were all collected.2.Based on the fact that whether the subjects had thrombus or not,they were divided into thrombus group and non-thrombus group.The data were analyzed by SPSS21.0 software,and whether PRUEVT occurred in patients with breast cancer chemotherapy was taken as a dependent variable.Multivariate Logistic regression analysis was performed with PRUEVT risk factors in breast cancer chemotherapy patients with statistical difference(p < 0.05).According to the results of multivariate Logistic regression analysis,the independent risk factors of PRUEVT in breast cancer chemotherapy patients were established,and the PRUEVT risk assessment model of breast cancer chemotherapy patients was constructed.The prediction effect of the risk assessment model was evaluated by the working characteristic curve of the subjects,and the optimal critical value for judging the high risk population of PRUEVT in patients with breast cancer chemotherapy was determined.Results:1.In this study,896 patients with breast cancer who met the inclusion criteria and exclusion criteria were investigated.The data of 830 patients with breast cancer chemotherapy PICC catheterization were collected,and the effective rate was 92.6%.Among 830 patients,The incidence of PRUEVT was 3.9% in 32 patients with clinical symptoms.2.Multivariate Logistic regression analysis showed that the variables entering the regression equation were obesity,diabetes history,chemotherapy history,ectopic catheter during catheterization,catheter blockage,catheter-related infection,bed rest more than 72 hours after catheterization,which was in accordance with PICC catheterization indication.WBC>12.0×109/ L,ectopic catheter after catheterization,chemotherapeutic drugs.The scoring system is constructed based on the variables' OR value.The sensitivity and specificity of this model are the best when 10.5 points are taken as the threshold value of high risk and low risk population.The sensitivity and specificity were 0.844 and 0.722 respectively.ROC Curve of scoring system The lower area(AUC)was 0.894(P < 0.001,95% CI: 0.836~0.952).Using H-L goodness of fit test,?2=5.191,P value is 0.520(> 0.05),and the model fits pretty well.There is no significant difference between the predicted value and the actual value of the model.Conclusion:1.The independent risk factors of PICC-associated venous thrombosis in patients with breast cancer were obesity,history of diabetes,history of chemotherapy,ectopic catheterization,blockage of catheter,catheter-related infection,and bed rest more than 72 hours after catheterization.When the indication of PICC catheterization was in accordance with WBC > 12.0 × 109/ L,the catheter was ectopic and chemotherapeutic drugs were used after catheterization.2.The risk assessment model of PRUEVT in patients with breast cancer chemotherapy can predict the risk of PRUEVT in patients with breast cancer chemotherapy,and can screen the high risk population of PICC-associated upper limb venous thrombosis in patients with breast cancer chemotherapy.3.The newly PICC-associated thrombus risk assessment tool developed by Professor Vineet Chopra of the University of Michigan School of Medicine in the United States is introduced.Some of the risk factors have certain reference significance for clinical breast cancer chemotherapy patients with PRUEVT.