植入式静脉输液港患者导管阻塞风险预测模型的构建与验证^*

Construction and Validation of a Risk Prediction Model for Catheter Blockage in Patients With Implantable Venous Access Ports

摘要

目的 探讨植入式静脉输液港（implantable venous access port，IVAP）患者发生导管阻塞的影响因素，并构建风险预测模型。方法 回顾性选取2022年1月-2024年3月行IVAP置入的563例患者，按7∶3比例随机分为建模组（n=394）与验证组（n=169）。采用单因素分析和多因素logistic回归（双向逐步回归法）筛选导管阻塞的独立影响因素，据此构建列线图预测模型，并分别从区分度、校准度及临床实用性三方面对模型进行验证与评估。结果 563例IVAP患者中，导管阻塞发生率为12.79%（72/563）。多因素logistic回归分析显示，体质指数（body mass index，BMI）≥24 kg/m²（OR=3.535，95%CI：1.500～8.329）、合并糖尿病（OR=3.723，95%CI：1.540～8.999）、合并恶性肿瘤（OR=3.161，95%CI：1.327～7.526）、血栓史（OR=3.324，95%CI：1.425～7.755）、D-二聚体升高（OR=547.088，95%CI：46.093～649.462）及导管留置时间≥6个月（OR=2.633，95%CI：1.060～6.543）是导管阻塞的独立危险因素，而定期维护（OR=0.200，95%CI：0.080～0.499）为其独立保护因素（均P<0.05）。建模组受试者工作特征（receiver operating characteristic，ROC）曲线下面积（area under the curve，AUC）为0.91（95%CI：0.87～0.96），验证组AUC为0.94（95%CI：0.88～1.00）；Hosmer-Lemeshow检验显示建模组（χ²=10.782，P=0.214）与验证组（χ²=3.744，P=0.879）模型拟合均良好；决策曲线分析（decision curve analysis，DCA）提示模型具有正向净临床收益。结论 本研究构建的IVAP导管阻塞风险预测模型具有良好的预测效能与临床实用价值，可为医护人员早期识别高危患者、实施个性化护理干预提供科学依据，有助于降低导管阻塞的发生风险。

Abstract

Objective To explore the influencing factors of catheter blockage in patients with implantable venous access ports (IVAP) and to construct a risk prediction model. Methods A total of 563 patients who underwent IVAP implantation from January 2022 to March 2024 were retrospectively enrolled and randomly divided into a modeling group (n = 394) and a validation group (n = 169) at a 7∶3 ratio. Univariate analysis and multivariate logistic regression (bidirectional stepwise regression) were used to identify independent influencing factors for catheter blockage. A nomogram prediction model was then constructed and evaluated in terms of discrimination, calibration, and clinical utility. Results The incidence of catheter blockage was 12.79% (72/563). Multivariate Logistic regression showed that body mass index (BMI) ≥ 24 kg/m² (OR = 3.535, 95%CI: 1.500–8.329), diabetes mellitus (OR = 3.723, 95%CI: 1.540–8.999), malignancy (OR = 3.161, 95%CI: 1.327–7.526), history of thrombosis (OR = 3.324, 95%CI: 1.425–7.755), elevated D-dimer (OR = 547.088, 95%CI: 46.093–649.462), and catheter retention time ≥ 6 months (OR = 2.633, 95%CI: 1.060–6.543) were independent risk factors, while regular maintenance (OR = 0.200, 95%CI: 0.080–0.499) was an independent protective factor (allP<0.05). The area under the receiver operating characteristic curve (AUC) of the nomogram model was 0.91 (95%CI: 0.87–0.96) in the modeling group and 0.94 (95%CI: 0.88–1.00) in the validation group. The Hosmer-Lemeshow test showed good calibration for both the modeling group (χ² = 10.782, P = 0.214) and the validation group (χ² = 3.744, P = 0.879). Decision curve analysis indicated a positive net clinical benefit. Conclusion The IVAP catheter blockage risk prediction model constructed in this study demonstrates good predictive performance and clinical utility. It can assist healthcare providers in early identification of high-risk patients and implementation of individualized preventive interventions, thereby reducing the incidence of catheter blockage.

关键词

植入式静脉输液港 / 导管阻塞 / 危险因素 / 预测模型

Key words

Implantable venous access port / Catheter blockage / Risk factors / Prediction model

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基金资助

*江苏省卫生应急研究所开放课题(JSWSYJ20240204)

徐州市重点研发计划（社会发展）项目(KC22236)

徐州市科技项目(KC23282)