A Study of Asymptomatic CRT in ICU Patients

Oct 26, 2023

The following is a summary of “Incidence of asymptomatic catheter-related thrombosis in intensive care unit patients: a prospective cohort study,” published in the October 2023 issue of Critical Care by Abbruzzese et al.

Catheter-related thrombosis (CRT) incidence and risk factors vary widely in the literature due to study design and methodology differences. Researchers started a prospective study to assess the incidence, incidence rate (IR), cumulative incidence, and risk factors of asymptomatic CRT in non-oncologic Intensive Care Unit (ICU) patients.

They assessed CRT development daily through ultrasound screening. CRT IRs were calculated as the number of CRT events per catheter day (cd). The cumulative incidence of CRTs was estimated using Kalbfleisch and Prentice’s method. Used Poisson regression models to calculate IR ratios for risk factor analysis.

The results showed 203 patients included, 50 (25%, 95% CI 19–31) experienced CRT, with 52 (14%, 95% CI 11–18) catheters inserted leading to CRT development [with an incidence rate of 17.7 (13.5–23.2) CRTs per 1000*cd] within 5 [3–10] days of insertion. Most CRTs (88%) were partial and asymptomatic. Obesity and ECMO support emerged as patient-related protective factors [IRR) 0.24 (0.10–0.60), P=0.002 and 0.05 (0.01–0.50), P=0.011]. CRT incidence rates were higher in the internal jugular vein than in other sites [20.1 vs. 5.9 CRTs per 1000*cd, IRR 4.22 (1.22–14.63), P=0.023]. Catheter-related risk factors included the pulmonary artery catheter and left-side cannulation [IRR 4.24 (2.00–9.00), P< 0.001 vs. central venous catheters; IRR 2.69 (1.45–4.98), P=0.002 vs. right cannulation]. There was no statistically significant effect of the number of simultaneously inserted catheters [IRR 1.11 (0.64–1.94), P=0.708] and catheterization length [IRR 1.09 (0.97–1.22), P=0.155]. CRT patients had a longer ICU length of stay (20 [15–31] days vs. 6 [4–14] days, P<0.001), while no difference in mortality was observed.