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Risk factors for subclavian vein thrombosis in cancer patients with total parenteral nutrition.

Berea-Baltierra R, Rivas-Ruiz R, Vela-Martinez E, Sevilla-Gonzalez Mde L, Talavera-Pina JO, Valencia-Jimenez E, Perez-Franco I, Escobedo-Hernandez L - J Clin Med Res (2014)

Bottom Line: Fifty-three point three percent of patients receiving ≥ 3,050 mOsm TPN in 24 hours developed SVT (relative risk (RR) = 2.01, 95% CI, 1.14 - 3.57; P = 0.016) at day 8 and 60% (RR = 1.67, 95% CI, 1.30 - 2.71; P = 0.038) at day 30 post-catheter placement.Protein administration of > 97.5 g/day was shown to be a risk factor for early thrombosis with a mean of 16.88 days for the development of SVT (95% CI, 10 - 23.7) versus 27.8 days (95% CI, 25.8 - 29.9) in the group with nutritional protein content < 97.5 g/day (P = 0.000).High-osmolarity and high-protein nutrition formulas were shown to be risk factors for SVT in cancer patients receiving TPN.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine and Nutritional Support, Oncology Hospital, Centro Medico Nacional Siglo XXI, Mexico City, Mexico.

ABSTRACT

Background: There are few reports on total parenteral nutrition (TPN) and its possible prothrombotic effect. The purpose of this study was to identify risk factors for subclavian vein thrombosis (SVT) in patients receiving TPN.

Method: Cancer patients with indwelling subclavian catheters and TPN were followed in a cohort study. Doppler ultrasound examination was performed 8 and 30 days after catheter placement.

Results: One hundred twenty-one patients were included, with a mean of 61 (± 11.8) years of age. We detected 36 SVT events at day 8 (29.8%) and 47 (38.8%) at day 30 after central catheter placement. Mean length of subclavian catheterization was 17.2 (± 8.2) days. Fifty-three point three percent of patients receiving ≥ 3,050 mOsm TPN in 24 hours developed SVT (relative risk (RR) = 2.01, 95% CI, 1.14 - 3.57; P = 0.016) at day 8 and 60% (RR = 1.67, 95% CI, 1.30 - 2.71; P = 0.038) at day 30 post-catheter placement. Protein administration of > 97.5 g/day was shown to be a risk factor for early thrombosis with a mean of 16.88 days for the development of SVT (95% CI, 10 - 23.7) versus 27.8 days (95% CI, 25.8 - 29.9) in the group with nutritional protein content < 97.5 g/day (P = 0.000).

Conclusion: High-osmolarity and high-protein nutrition formulas were shown to be risk factors for SVT in cancer patients receiving TPN.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier plot. Time for the development of subclavian vein thrombosis according to fibrinogen levels.
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Figure 2: Kaplan-Meier plot. Time for the development of subclavian vein thrombosis according to fibrinogen levels.

Mentions: In view of this finding, we tried to find a cutoff point in order to establish the risk of thrombosis according to the levels of fibrinogen. By means of an ROC analysis, we found that fibrinogen levels less than or equal to 550 mg/dL had an area under the curve (AUC) of 0.675 (0.571 - 0.78), P = 0.002, with a sensitivity of 66.7% and specificity of 61.2% for thrombosis at day 8, and an AUC of 0.745 (0.655 - 0.834), P = 0.000, with a sensitivity of 70% and specificity of 67.6% for thrombosis at day 30. A Kaplan-Meier analysis showed that this effect was related to the time for the development of SVT, with a mean of 19.6 (95% CI, 16.8 - 22.4) days in patients with fibrinogen levels < 550 mg/mL and a mean of 26.3 (95% CI, 24.1 - 28.5) days in patients with fibrinogen > 550 mg/mL (P < 0.000) (Fig. 2).


Risk factors for subclavian vein thrombosis in cancer patients with total parenteral nutrition.

Berea-Baltierra R, Rivas-Ruiz R, Vela-Martinez E, Sevilla-Gonzalez Mde L, Talavera-Pina JO, Valencia-Jimenez E, Perez-Franco I, Escobedo-Hernandez L - J Clin Med Res (2014)

Kaplan-Meier plot. Time for the development of subclavian vein thrombosis according to fibrinogen levels.
© Copyright Policy - open access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4125329&req=5

Figure 2: Kaplan-Meier plot. Time for the development of subclavian vein thrombosis according to fibrinogen levels.
Mentions: In view of this finding, we tried to find a cutoff point in order to establish the risk of thrombosis according to the levels of fibrinogen. By means of an ROC analysis, we found that fibrinogen levels less than or equal to 550 mg/dL had an area under the curve (AUC) of 0.675 (0.571 - 0.78), P = 0.002, with a sensitivity of 66.7% and specificity of 61.2% for thrombosis at day 8, and an AUC of 0.745 (0.655 - 0.834), P = 0.000, with a sensitivity of 70% and specificity of 67.6% for thrombosis at day 30. A Kaplan-Meier analysis showed that this effect was related to the time for the development of SVT, with a mean of 19.6 (95% CI, 16.8 - 22.4) days in patients with fibrinogen levels < 550 mg/mL and a mean of 26.3 (95% CI, 24.1 - 28.5) days in patients with fibrinogen > 550 mg/mL (P < 0.000) (Fig. 2).

Bottom Line: Fifty-three point three percent of patients receiving ≥ 3,050 mOsm TPN in 24 hours developed SVT (relative risk (RR) = 2.01, 95% CI, 1.14 - 3.57; P = 0.016) at day 8 and 60% (RR = 1.67, 95% CI, 1.30 - 2.71; P = 0.038) at day 30 post-catheter placement.Protein administration of > 97.5 g/day was shown to be a risk factor for early thrombosis with a mean of 16.88 days for the development of SVT (95% CI, 10 - 23.7) versus 27.8 days (95% CI, 25.8 - 29.9) in the group with nutritional protein content < 97.5 g/day (P = 0.000).High-osmolarity and high-protein nutrition formulas were shown to be risk factors for SVT in cancer patients receiving TPN.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine and Nutritional Support, Oncology Hospital, Centro Medico Nacional Siglo XXI, Mexico City, Mexico.

ABSTRACT

Background: There are few reports on total parenteral nutrition (TPN) and its possible prothrombotic effect. The purpose of this study was to identify risk factors for subclavian vein thrombosis (SVT) in patients receiving TPN.

Method: Cancer patients with indwelling subclavian catheters and TPN were followed in a cohort study. Doppler ultrasound examination was performed 8 and 30 days after catheter placement.

Results: One hundred twenty-one patients were included, with a mean of 61 (± 11.8) years of age. We detected 36 SVT events at day 8 (29.8%) and 47 (38.8%) at day 30 after central catheter placement. Mean length of subclavian catheterization was 17.2 (± 8.2) days. Fifty-three point three percent of patients receiving ≥ 3,050 mOsm TPN in 24 hours developed SVT (relative risk (RR) = 2.01, 95% CI, 1.14 - 3.57; P = 0.016) at day 8 and 60% (RR = 1.67, 95% CI, 1.30 - 2.71; P = 0.038) at day 30 post-catheter placement. Protein administration of > 97.5 g/day was shown to be a risk factor for early thrombosis with a mean of 16.88 days for the development of SVT (95% CI, 10 - 23.7) versus 27.8 days (95% CI, 25.8 - 29.9) in the group with nutritional protein content < 97.5 g/day (P = 0.000).

Conclusion: High-osmolarity and high-protein nutrition formulas were shown to be risk factors for SVT in cancer patients receiving TPN.

No MeSH data available.


Related in: MedlinePlus