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Development and Validation of a Dynamic Online Nomogram for Predicting Central Venous Catheter-Related Thrombosis in

Weihong Jiang¹, Jun Zhou¹, Jiajia Zhu¹

¹Cardiac Intensive Care Unit, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang Province, China.

Journal of Clinical Nursing

|June 3, 2025

Insights

A new nomogram helps predict central venous catheter-related thrombosis (CRT) in children with congenital heart disease. This tool aids clinicians in identifying at-risk patients for better outcomes.

Area of Science:

Pediatric Cardiology
Vascular Thrombosis Research
Medical Device Development

Background:

Children with congenital heart disease (CHD) have a higher risk of central venous catheter-related thrombosis (CRT).
CRT is associated with poor clinical outcomes, and early detection is crucial for improving prognosis.
Currently, no validated tools exist to specifically assess CRT risk in this vulnerable pediatric population.

Purpose of the Study:

To develop and validate a predictive tool for estimating the risk of CRT in pediatric patients with CHD.
To create a dynamic online nomogram for practical clinical use.

Main Methods:

A cross-sectional study involving 503 children with CHD, divided into modeling (n=403) and validation (n=100) cohorts.
Binary logistic regression was used to build a predictive model, which was then developed into a dynamic online nomogram.
Model performance was assessed using ROC analysis, Hosmer-Lemeshow test, and decision curve analysis, adhering to TRIPOD guidelines.

Main Results:

The prevalence of CRT was 23.57% in the modeling cohort and 21.00% in the validation cohort.
Key predictors identified included duration of catheterization, ICU stay, sedation, high fibrinogen levels, and elevated platelet count.
The nomogram demonstrated strong discriminatory power with an AUC of 0.866 (modeling) and 0.761 (validation), and showed good calibration and clinical utility.

Conclusions:

A dynamic online nomogram was successfully developed, demonstrating high predictive accuracy for CRT in children with CHD.
This nomogram serves as a practical tool for healthcare providers to stratify risk and guide targeted interventions for CRT prevention and management.

Read full analysis

Abstract

Aims:

To develop and validate a tool to estimate the risk of central venous catheter-related thrombosis (CRT) in children with congenital heart disease.

Background:

Children with congenital heart disease face an elevated risk of CRT, which is closely linked to adverse clinical outcomes. Early detection of CRT may improve prognosis and reduce mortality. However, no specific tools currently exist to effectively assess it.

Design:

A cross-sectional study.

Methods:

From January 2020 to April 2023, we enrolled 503 children with congenital heart disease. Four hundred and three were assigned to the modelling cohort and 100 to the validation cohort. Using binary logistic regression, a predictive model was constructed, followed by the development of a dynamic online nomogram. The model's internal and external verification were performed using ROC analysis, the Hosmer-Lemeshow test, and decision curve analysis, respectively. The study adhered to the TRIPOD guidelines.

Results:

The prevalence of CRT in the modelling cohort and validation cohort was 23.57% and 21.00%, respectively. Logistic regression analysis identified duration of catheterization, length of ICU stay, duration of sedation, fibrinogen ≥ 4 g/L and platelet count ≥ 400 × 10⁹/L as independent predictive factors for CRT, all of which were incorporated into the nomogram. The nomogram achieved an AUC of 0.866 in the modelling cohort and 0.761 in the validation cohort, demonstrating strong discriminatory power. In both cohorts, the calibration curve indicated good agreement and decision curve analysis confirmed its significant clinical utility.

Conclusions:

We developed a dynamic online nomogram that demonstrated strong predictive accuracy and was practical for identifying CRT in children with congenital heart disease.

Relevance To Clinical Practice:

This nomogram enables healthcare providers to estimate the risk of CRT in children with congenital heart disease, offering an effective tool for risk stratification and a basis for implementing targeted interventions.

Patient Or Public Contribution:

No patient or public contribution.

Keywords:

children congenital heart disease nomogram prediction model risk factors thrombosis

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