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Incidence of asymptomatic catheter-related thrombosis in intensive care unit patients: a prospective cohort study

BACKGROUND: Catheter-related thrombosis (CRT) incidence, rate, and risk factors vary in literature due to differences in populations, catheters, diagnostic methods, and statistical approaches. The aim of this single-center, prospective, observational study was to assess incidence, incidence rate (IR...

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Autores principales: Abbruzzese, Chiara, Guzzardella, Amedeo, Consonni, Dario, Turconi, Gloria, Bonetti, Claudia, Brioni, Matteo, Panigada, Mauro, Grasselli, Giacomo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10587047/
https://www.ncbi.nlm.nih.gov/pubmed/37858003
http://dx.doi.org/10.1186/s13613-023-01206-w
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author Abbruzzese, Chiara
Guzzardella, Amedeo
Consonni, Dario
Turconi, Gloria
Bonetti, Claudia
Brioni, Matteo
Panigada, Mauro
Grasselli, Giacomo
author_facet Abbruzzese, Chiara
Guzzardella, Amedeo
Consonni, Dario
Turconi, Gloria
Bonetti, Claudia
Brioni, Matteo
Panigada, Mauro
Grasselli, Giacomo
author_sort Abbruzzese, Chiara
collection PubMed
description BACKGROUND: Catheter-related thrombosis (CRT) incidence, rate, and risk factors vary in literature due to differences in populations, catheters, diagnostic methods, and statistical approaches. The aim of this single-center, prospective, observational study was to assess incidence, incidence rate (IR), cumulative incidence, and risk factors by means of IR ratio (IRR) of asymptomatic CRT in a non-oncologic Intensive Care Unit (ICU) population. CRT development was assessed daily by means of ultrasound screening. The proportions of patients and catheters developing CRT and CRT incidence rates, expressed as the number of events per catheter-days (cd), were calculated. Kalbfleisch and Prentice’s method was used to estimate the cumulative incidence of CRTs. Univariate and multivariable Poisson regression models were fitted to calculate IRR in risk factors analysis. RESULTS: Fifty (25%, 95% CI 19–31) out of 203 included patients, and 52 (14%, 95% CI 11–18) out of 375 catheters inserted developed CRT [IR 17.7 (13.5–23.2) CRTs/1000*cd], after 5 [3–10] days from insertion. Forty-six CRTs (88%) were partial thrombosis. All CRTs remained asymptomatic. Obesity and ECMO support were patient-related protective factors [IRR 0.24 (0.10–0.60), p = 0.002 and 0.05 (0.01–0.50), p = 0.011, respectively]. The internal jugular vein had higher CRT IR than other sites [20.1 vs. 5.9 CRTs/1000*cd, IRR 4.22 (1.22–14.63), p = 0.023]. Pulmonary artery catheter and left-side cannulation were catheter-related risk factors [IRR 4.24 (2.00–9.00), p < 0.001 vs. central venous catheters; IRR 2.69 (1.45–4.98), p = 0.002 vs. right cannulation, respectively]. No statistically significant effect of the number of simultaneously inserted catheters [IRR 1.11 (0.64–1.94), p = 0.708] and of the catheterization length [IRR 1.09 (0.97–1.22), p = 0.155] was detected. The ICU length of stay was longer in CRT patients (20 [15–31] vs. 6 [4–14] days, p < 0.001), while no difference in mortality was observed. CONCLUSIONS: CRTs are frequent but rarely symptomatic. This study suggests that obesity and ECMO are protective factors, while pulmonary artery catheter, internal jugular vein and left-side positioning are risk factors for CRT. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13613-023-01206-w.
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spelling pubmed-105870472023-10-21 Incidence of asymptomatic catheter-related thrombosis in intensive care unit patients: a prospective cohort study Abbruzzese, Chiara Guzzardella, Amedeo Consonni, Dario Turconi, Gloria Bonetti, Claudia Brioni, Matteo Panigada, Mauro Grasselli, Giacomo Ann Intensive Care Research BACKGROUND: Catheter-related thrombosis (CRT) incidence, rate, and risk factors vary in literature due to differences in populations, catheters, diagnostic methods, and statistical approaches. The aim of this single-center, prospective, observational study was to assess incidence, incidence rate (IR), cumulative incidence, and risk factors by means of IR ratio (IRR) of asymptomatic CRT in a non-oncologic Intensive Care Unit (ICU) population. CRT development was assessed daily by means of ultrasound screening. The proportions of patients and catheters developing CRT and CRT incidence rates, expressed as the number of events per catheter-days (cd), were calculated. Kalbfleisch and Prentice’s method was used to estimate the cumulative incidence of CRTs. Univariate and multivariable Poisson regression models were fitted to calculate IRR in risk factors analysis. RESULTS: Fifty (25%, 95% CI 19–31) out of 203 included patients, and 52 (14%, 95% CI 11–18) out of 375 catheters inserted developed CRT [IR 17.7 (13.5–23.2) CRTs/1000*cd], after 5 [3–10] days from insertion. Forty-six CRTs (88%) were partial thrombosis. All CRTs remained asymptomatic. Obesity and ECMO support were patient-related protective factors [IRR 0.24 (0.10–0.60), p = 0.002 and 0.05 (0.01–0.50), p = 0.011, respectively]. The internal jugular vein had higher CRT IR than other sites [20.1 vs. 5.9 CRTs/1000*cd, IRR 4.22 (1.22–14.63), p = 0.023]. Pulmonary artery catheter and left-side cannulation were catheter-related risk factors [IRR 4.24 (2.00–9.00), p < 0.001 vs. central venous catheters; IRR 2.69 (1.45–4.98), p = 0.002 vs. right cannulation, respectively]. No statistically significant effect of the number of simultaneously inserted catheters [IRR 1.11 (0.64–1.94), p = 0.708] and of the catheterization length [IRR 1.09 (0.97–1.22), p = 0.155] was detected. The ICU length of stay was longer in CRT patients (20 [15–31] vs. 6 [4–14] days, p < 0.001), while no difference in mortality was observed. CONCLUSIONS: CRTs are frequent but rarely symptomatic. This study suggests that obesity and ECMO are protective factors, while pulmonary artery catheter, internal jugular vein and left-side positioning are risk factors for CRT. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13613-023-01206-w. Springer International Publishing 2023-10-19 /pmc/articles/PMC10587047/ /pubmed/37858003 http://dx.doi.org/10.1186/s13613-023-01206-w Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Research
Abbruzzese, Chiara
Guzzardella, Amedeo
Consonni, Dario
Turconi, Gloria
Bonetti, Claudia
Brioni, Matteo
Panigada, Mauro
Grasselli, Giacomo
Incidence of asymptomatic catheter-related thrombosis in intensive care unit patients: a prospective cohort study
title Incidence of asymptomatic catheter-related thrombosis in intensive care unit patients: a prospective cohort study
title_full Incidence of asymptomatic catheter-related thrombosis in intensive care unit patients: a prospective cohort study
title_fullStr Incidence of asymptomatic catheter-related thrombosis in intensive care unit patients: a prospective cohort study
title_full_unstemmed Incidence of asymptomatic catheter-related thrombosis in intensive care unit patients: a prospective cohort study
title_short Incidence of asymptomatic catheter-related thrombosis in intensive care unit patients: a prospective cohort study
title_sort incidence of asymptomatic catheter-related thrombosis in intensive care unit patients: a prospective cohort study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10587047/
https://www.ncbi.nlm.nih.gov/pubmed/37858003
http://dx.doi.org/10.1186/s13613-023-01206-w
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