Inflammation-coagulation biomarkers predict catheter-related thrombosis following peripherally inserted central catheter placement in patients with hematologic malignancies: a retrospective cohort study

Background: Patients with hematologic malignancies are at high risk of developing catheter-related thrombosis (CRT) following peripherally inserted central catheter (PICC) placement; however, reliable prediction tools based on inflammation and coagulation biomarkers remain limited. This study aimed to investigate inflammation and coagulation biomarkers associated with CRT and to construct an individualized risk prediction model.

Methods: This retrospective study enrolled 172 patients with hematologic malignancies who underwent PICC placement (April 2022–December 2023). Inflammatory [white blood cell count, C-reactive protein (CRP), interleukin (IL)-6, IL-1β] and coagulation [fibrinogen (FIB), D-dimer (D-D), international normalized ratio (INR), activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT)] indicators were collected. Patients were classified into the CRT and non-CRT groups according to the occurrence of CRT, defined as both symptomatic and asymptomatic thrombi detected by scheduled upper-extremity duplex ultrasound following PICC placement. Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression were used to identify independent risk factors. A nomogram was built and validated internally using receiver operating characteristic (ROC) curves, decision curve analysis (DCA), calibration curves, and bootstrap.

Results: Overall CRT, including both symptomatic and asymptomatic events detected by scheduled upper-extremity ultrasound screening following PICC placement, occurred in 58 patients (33.7%; 15 symptomatic and 43 asymptomatic). The median time to thrombus was 17.5 days [interquartile range (IQR), 12.5–28.0 days]. Platelet count (PLT), IL-1β, CRP, IL-6, FIB, D-D, PT, and TT were higher in the CRT group (all P<0.05). Multivariate analysis identified PLT [odds ratio (OR) =0.936], IL-1β (OR =1.375), CRP (OR =1.367), IL-6 (OR =1.134), FIB (OR =1.870), and D-D (OR =1.005) as independent risk factors (all P<0.05). The nomogram achieved an area under the receiver operating characteristic curve (AUC) of 0.947 [95% confidence interval (CI): 0.909–0.986] with good calibration.

Conclusions: PLT, IL-1β, CRP, IL-6, FIB, and D-D are independently associated with CRT following PICC placement in patients with hematologic malignancies. The prediction model performed well internally but requires external multi-center validation before clinical application.