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肿瘤患者PICC相关性静脉血栓风险预测模型的系统评价
作者:曾裕1  刘颖1  蒋红梅1  廖疏影1  刘蕾1  杨娟1  蒋璐西2  江庆华3 
单位:1. 成都医学院 护理学院, 四川 成都 610500;
2. 电子科技大学 医学院, 四川 成都 610051;
3. 四川省肿瘤临床医学研究中心/四川省肿瘤医院研究所/四川省癌症防治中心/电子科技大学附属肿瘤医院 放疗科, 四川 成都 610041
关键词:肿瘤 经外周静脉置入中心静脉导管 血栓 预测模型 系统评价 
分类号:R473.73
出版年·卷·期(页码):2023·51·第十期(1371-1378)
摘要:

目的:对肿瘤患者经外周静脉置入中心静脉导管(PICC)相关性静脉血栓风险预测模型进行系统评价,为临床实践提供一定的参考。方法:利用计算机检索中国知网、中国生物医学文献数据库、万方、维普、PubMed、Web Of Science、Embase和CINAHL数据库中与主题相关的文献,检索时间为建库至2022年11月22日,由两名研究人员根据纳入、排除标准筛选文献。根据预测模型研究系统评价的关键评估和数据提取清单(CHARMS)独立进行预测模型相关资料的提取,利用PROBAST工具独立对文献偏倚风险(ROB)和适用性进行评估。采用描述性分析法对预测模型的基本特征及纳入研究的ROB和适用性评估结果进行总结。结果:本研究共纳入12篇文献,研究类型主要是前瞻性队列研究和回顾性队列研究,共计8 198例患者。利用Logistic回归、COX回归、人工神经网络(ANN)、LASSO回归、随机森林算法(RF)构建了17个预测模型,其中16个预测模型报告了受试者工作特征曲线下面积(AUC),4项研究对模型进行了校准度的评估,9项研究对模型进行了内部验证。D-二聚体指标升高、合并糖尿病、PICC置管史、肿瘤分期高、吸烟史、营养风险筛查2002(NRS2002)评分是模型中包含最多的预测因子。ROB评估发现12篇文献均有高偏倚风险,造成高偏倚风险的原因主要有样本量过少、未处理缺失数据、缺乏外部验证、基于单变量分析筛选预测因子、缺乏模型性能评估及模型过度拟合。适用性评估发现4项研究具有高适用性,低适用性的原因主要是纳入文献的研究对象局限于年龄>18岁的患者。结论:肿瘤患者PICC相关性静脉血栓风险预测模型总体上具有良好的区分度、校准度及适用性,但仍存在方法学的缺陷及ROB。在未来应注重预测模型的数据处理分析方法、外部验证及校准度的评估,开发预测性能优良、适用性高的模型,为临床医疗决策提供更多的帮助。

参考文献:

[1] SUNG H, FERLAY J, SIEGEL R L, et al.Global Cancer Statistics 2020:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J].CA Cancer J Clin, 2021, 71(3):209-249.
[2] ZOCHIOS V, UMAR I, SIMPSON N, et al.Peripherally inserted central catheter(PICC)-related thrombosis in critically ill patients[J].J Vasc Access, 2014, 15(5):329-337.
[3] WANG G R, LI Y F, WU C L, et al.The clinical features and related factors of PICC-related upper extremity asymptomatic venous thrombosis in cancer patients[J].Medicine(Baltimore), 2020, 99(12):e19409.
[4] 田婷, 黄锐娜, 戚熠, 等.肿瘤患者PICC置管相关静脉血栓形成危险因素Meta分析[J].护理学报, 2019, 26(11):49-54.
[5] LUO L, JING X M, WANG G R, et al.Peripherally inserted central catheter-related upper extremity venous thrombosis in oncology patients[J].J Ultrasound Med, 2016, 35(8):1759-1763.
[6] KANG J R, CHEN W, SUN W Y, et al.Peripherally inserted central catheter-related complications in cancer patients:a prospective study of over 50, 000 catheter days[J].J Vasc Access, 2017, 18(2):153-157.
[7] CHOPRA V, ANAND S, HICKNER A, et al.Risk of venous thromboembolism associated with peripherally inserted central catheters:a systematic review and meta-analysis[J].Lancet, 2013, 382(9889):311-325.
[8] JONES D, WISMAYER K, BOZAS G, et al.The risk of venous thromboembolism associated with peripherally inserted central catheters in ambulant cancer patients[J].Thromb J, 2017, 15(1):25.
[9] MOONS K G M, DE GROOT J A, BOUWMEESTER W, et al.Critical appraisal and data extraction for systematic reviews of prediction modelling studies:the CHARMS checklist[J].PLoS Med, 2014, 11(10):e1001744.
[10] WOLFF R F, MOONS K G M, RILEY R D, et al.PROBAST:a tool to assess the risk of bias and applicability of prediction model studies[J].Ann Intern Med, 2019, 170(1):51-58.
[11] MOONS K G M, WOLFF R F, RILEY R D, et al.PROBAST:a tool to assess risk of bias and applicability of prediction model studies:explanation and elaboration[J].Ann Intern Med, 2019, 170(1):W1-W33.
[12] 陈香萍, 张奕, 庄一渝, 等.PROBAST:诊断或预后多因素预测模型研究偏倚风险的评估工具[J].中国循证医学杂志, 2020, 20(6):737-744.
[13] 陈茹, 王胜锋, 周家琛, 等.预测模型研究的偏倚风险和适用性评估工具解读[J].中华流行病学杂志, 41(5):776-781.
[14] 董鲜桃, 张永杰, 朱姝, 等.肺癌化疗患者经外周静脉穿刺的中心静脉导管置管后发生上肢深静脉血栓的危险因素及其风险预测列线图模型构建[J].实用心脑肺血管病杂志, 2022, 30(8):8-12.
[15] 高利琴, 赵林芳, 杨方英, 等.肺癌患者PICC相关性静脉血栓的风险预测列线图模型构建与评价[J].护理与康复, 2022, 21(5):6-12.
[16] 周纪云, 王爱红, 卢菲, 等.血液系统恶性肿瘤病人PICC相关性血栓风险预测模型的构建[J].护理研究, 2022, 36(10):1758-1763.
[17] FU J Q, CAI W F, ZENG B W, et al.Development and validation of a predictive model for peripherally inserted central catheter-related thrombosis in breast cancer patients based on artificial neural network:a prospective cohort study[J].Int J Nurs Stud, 2022, 135:104341.
[18] PENG S Y, WEI T, LI X Y, et al.A model to assess the risk of peripherally inserted central venous catheter-related thrombosis in patients with breast cancer:a retrospective cohort study[J].Support Care Cancer, 2022, 30(2):1127-1137.
[19] YUE J, ZHANG Y, XU F, et al.A clinical study of peripherally inserted central catheter-related venous thromboembolism in patients with hematological malignancies[J].Sci Rep, 2022, 12(1):9871.
[20] 孙玉萍, 宋岗, 张建美, 等.基于机器学习的PICC相关性上肢深静脉血栓形成预测[J].循证护理, 2021, 7(15):2071-2075.
[21] SONG X M, LU H, CHEN F, et al.A longitudinal observational retrospective study on risk factors and predictive model of PICC associated thrombosis in cancer patients[J].Sci Rep, 2020, 10(1):10090.
[22] 杨方英, 华荣誉, 吴婉英, 等.肿瘤患者外周静脉置入中心静脉导管相关性上肢静脉血栓风险预测列线图模型构建[J].肿瘤研究与临床, 2020, 32(7):456-461.
[23] LIU S S, ZHANG F Y, XIE L L, et al.Machine learning approaches for risk assessment of peripherally inserted central catheter-related vein thrombosis in hospitalized patients with cancer[J].Int J Med Inform, 2019, 129:175-183.
[24] 张昊, 谢欣, 周章剑, 等.列线图预测恶性肿瘤患者PICC导管相关血栓风险的研究[J].中国肿瘤临床, 2018, 45(3):137-141.
[25] 朱薇.肿瘤患者PICC导管相关性血栓形成风险评估表的构建[D].南宁:广西医科大学, 2018.
[26] MOONS K G M, ROYSTON P, VERGOUWE Y, et al.Prognosis and prognostic research:what, why, and how?[J].BMJ, 2009, 338:b375.
[27] MOONS K G M, KENGNE A P, WOODWARD M, et al.Risk prediction models:I.Development, internal validation, and assessing the incremental value of a new(bio)marker[J].Heart, 2012, 98(9):683-690.
[28] COWLEY L E, FAREWELL D M, MAGUIRE S, et al.Methodological standards for the development and evaluation of clinical prediction rules:a review of the literature[J].Diagn Progn Res, 2019, 3:16.
[29] HENDRIKSEN J M T, GEERSING G J, MOONS K G M, et al.Diagnostic and prognostic prediction models[J].J Thromb Haemost, 2013, 11:129-141.
[30] HEINZE G, DUNKLER D.Five myths about variable selection[J].Transpl Int, 2017, 30(1):6-10.
[31] VAN SMEDEN M, MOONS K G, DE GROOT J A, et al.Sample size for binary logistic prediction models:beyond events per variable criteria[J].Stat Methods Med Res, 2019, 28(8):2455-2474.
[32] RILEY R D, ENSOR J, SNELL K I E, et al.Calculating the sample size required for developing a clinical prediction model[J].BMJ, 2020, 368:m441.
[33] WYNANTS L, COLLINS G S, VAN CALSTER B.Key steps and common pitfalls in developing and validating risk models[J].BJOG, 2016, 124(3):423-432.
[34] 邓建新, 单路宝, 贺德强, 等.缺失数据的处理方法及其发展趋势[J].统计与决策, 2019, 35(23):28-34.
[35] COLLINS G S, OGUNDIMU E O, COOK J A, et al.Quantifying the impact of different approaches for handling continuous predictors on the performance of a prognostic model[J].Stat Med, 2016, 35(23):4124-4135.
[36] STEYERBERG E W, UNO H, IOANNIDIS J P A, et al.Poor performance of clinical prediction models:the harm of commonly applied methods[J].J Clin Epidemiol, 2018, 98:133-143.
[37] 吕梦颖, 卢大松, 李香梅, 等.不同锻炼方式预防老年肿瘤患者PICC相关性血栓的研究[J].现代医学, 2021, 49(1):64-68.
[38] VAN CALSTER B, VICKERS A J.Calibration of risk prediction models:impact on decision-analytic performance[J].Med Decis Making, 2015, 35(2):162-169.

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