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Development and validation of a nomogram risk prediction model for PICC-related thrombosis in children with
Maoling Fu1,2, Qiaoyue Yang1,2, Xiao Wu1
1Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Insights
A new tool can predict peripherally inserted central catheter (PICC)-related thrombosis in children with blood cancers. This aids early identification of high-risk patients, improving outcomes and preventing complications.
Area of Science:
- Pediatric Hematology
- Vascular Access Devices
- Thrombosis Research
Background:
- Peripherally inserted central catheter (PICC)-related thrombosis is a significant complication in pediatric hematological malignancies.
- Early identification of at-risk patients is critical for effective prevention strategies.
Purpose of the Study:
- To develop and validate a clinical risk prediction tool for PICC-related thrombosis in pediatric patients with hematological malignancies.
- To identify independent risk factors associated with PICC-related thrombosis in this population.
Main Methods:
- Retrospective analysis of 519 children with hematological malignancies undergoing PICC catheterization.
- Analysis of 54 potential predictor variables to identify independent risk factors.
- Development and validation of a prediction model using training and validation sets, assessed by AUC, calibration, and decision curve analysis.
Main Results:
- PICC-related thrombosis occurred in 98 (18.9%) of the studied children.
- Six independent risk factors were identified: leukemia, number of catheters, catheterization history, total parenteral nutrition, post-catheterization D-dimer, and post-catheterization fibrinogen.
- The prediction model demonstrated good performance with AUCs of 0.844 (training) and 0.794 (validation).
Conclusions:
- A validated clinical prediction tool, visualized via nomogram, can effectively support the early prediction of PICC-related thrombosis in pediatric hematological malignancy patients.
- The model shows significant clinical utility for identifying high-risk individuals, enabling timely intervention and potentially reducing complication rates.
Abstract:
Early identification of high-risk patients is crucial for preventing peripherally intravenous central catheter (PICC)-related thrombosis in children with hematological malignancies. This study aims to develop and validate a clinical risk prediction tool for PICC-related thrombosis. A retrospective analysis was conducted on 519 children with hematological malignancies who underwent PICC catheterization at Tongji Hospital between January 2018 and December 2023. Among these children, 98 (18.9%) developed PICC-related thrombosis. A total of 54 potential predictor variables were analyzed, and six independent risk factors were identified: leukemia, number of catheters, history of catheterization, total parenteral nutrition, post-catheterization D-dimer, and post-catheterization fibrinogen. The prediction model constructed based on these factors demonstrated good predictive performance with the area under the curve of 0.844 (95% CI 0.787-0.900) for the training set and 0.794 (95% CI 0.698-0.890) for the validation set. The calibration curve and decision curve analysis further validated the good calibration and utility of the model. Through the visualization of nomogram, the model can provide strong support for the early prediction of PICC-related thrombosis in children with hematological malignancies and holds significant clinical application value.
