Incidence and risk factors for catheter-related thrombosis in elderly patients with malignant tumors: a single-center retrospective cohort study

Vollständiger Abstract

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Background Peripherally inserted central catheters (PICCs) are widely used in hospitalized patients with cancer for chemotherapy, nutritional support, and routine medication infusion. Catheter-related venous thrombosis (CRT) is a severe complication that is associated with poor prognosis, especially among elderly patients with cancer. However, studies on the identification of risk factors for CRT in elderly patients with cancer are limited. Methods From June 2024 to May 2025, clinical data from hospitalized elderly patients (aged over 60 years) with digestive system tumors (DSTs) or gynecologic tumors (GTs) were collected. A total of 270 patients who underwent PICC were enrolled. Among them, 46 patients were diagnosed with CRT. Basic demographic data, clinical records, catheter placement details, and coagulation indicators were collected. The risk factors for CRT were assessed via univariate and multivariate unconditional logistic regression. Receiver operating characteristic (ROC) curve analysis was subsequently performed to verify the efficacy of combined markers for predicting CRT. Results There were 120 patients with DSTs and 150 patients with GTs. Symptomatic CRT occurred in 46 patients (17.04%), including 26 (56.5%) with DSTs and 20 (43.5%) with GTs. Compared with the non-CRT group, white blood cell (WBC) count and D-dimer and hs-CRP levels were significantly increased in the CRT group, whereas the platelet count was significantly decreased. Multivariate regression analysis revealed that a history of thromboembolism, use of mechanical ventilation, distant metastasis of cancer, elevated WBC count, D-dimer, hs-CRP, and decreased platelet count were independent risk factors for CRT in hospitalized patients with tumors (P < 0.05). A predictive nomogram incorporating these four variables was constructed. The model demonstrated excellent discrimination, with an apparent C-statistic of 0.992 in the training cohort, an optimism-corrected AUC of 0.986, and an AUC of 0.971 (95% CI: 0.93–1.00) in the independent test set. Conclusion Elevated WBC counts, D-dimer and hs-CRP levels, and decreased platelet counts are independent risk factors for CRT among hospitalized elderly patients with cancer. The predictive model shows promising discriminative ability and potential clinical utility, warranting further external validation.