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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

Forrest plot of HRs for venous subclavian vein thrombosis at day 30 from the start of TPN.
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Figure 6: Forrest plot of HRs for venous subclavian vein thrombosis at day 30 from the start of TPN.

Mentions: By means of multiple logistic regression analyses, we found that TPN formulas with osmolarity over 3,050 mOsm/day (hazard ratio (HR) = 7.56; 95% CI, 2.04 - 28.01; P = 0.002 at day 8, and HR = 7.97; 95% CI, 2.15 - 29.53; P = 0.002 at day 30) and fibrinogen levels < 550 mg/dL (HR = 5.45; 95% CI, 2.02 - 14.7; P = 0.001 at day 8, and HR = 8.46; 95% CI, 3.27 - 21.8; P = 0.000 at day 30) were significant predictors of subclavian thrombosis with a global effect of up to 71.1% at day 30 (-2log likelihood = 134.4, r2 = 0.201). HRs for subclavian venous thrombosis and high osmolarity formulas were compared in a Forrest plot against previously known risk factors mentioned in literature (Fig. 5, 6).


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)

Forrest plot of HRs for venous subclavian vein thrombosis at day 30 from the start of TPN.
© Copyright Policy - open access
Related In: Results  -  Collection

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

Figure 6: Forrest plot of HRs for venous subclavian vein thrombosis at day 30 from the start of TPN.
Mentions: By means of multiple logistic regression analyses, we found that TPN formulas with osmolarity over 3,050 mOsm/day (hazard ratio (HR) = 7.56; 95% CI, 2.04 - 28.01; P = 0.002 at day 8, and HR = 7.97; 95% CI, 2.15 - 29.53; P = 0.002 at day 30) and fibrinogen levels < 550 mg/dL (HR = 5.45; 95% CI, 2.02 - 14.7; P = 0.001 at day 8, and HR = 8.46; 95% CI, 3.27 - 21.8; P = 0.000 at day 30) were significant predictors of subclavian thrombosis with a global effect of up to 71.1% at day 30 (-2log likelihood = 134.4, r2 = 0.201). HRs for subclavian venous thrombosis and high osmolarity formulas were compared in a Forrest plot against previously known risk factors mentioned in literature (Fig. 5, 6).

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