Association between early post-insertion arterial oxygen tension and documented acute upper-body deep or central venous thrombosis in critically ill adults: A retrospective MIMIC-IV cohort study.

چکیده اصلی

Abnormal oxygenation may influence thrombosis, but evidence in catheterized critically ill patients remains limited. We examined whether the first arterial partial pressure of oxygen (PaO2) measured within 24 hours after qualifying invasive venous catheter insertion was associated with documented acute upper-body deep or central venous thrombosis during hospitalization. This retrospective observational cohort study used the Medical Information Mart for Intensive Care IV database, version 2.2 (MIMIC-IV v2.2) (2008-2019). Adult intensive care unit admissions were included when a qualifying invasive venous catheter was present and an arterial PaO2 measurement was obtained after insertion, within 24 hours, and while the catheter remained in situ. PaO2 was analyzed continuously and categorically (≤80, 81-100, and >100 mmHg). Logistic regression models sequentially adjusted for patient characteristics, laboratory measurements, catheter characteristics, measurement timing, inspired oxygen concentration, respiratory support, and non-respiratory organ dysfunction. Multiple imputation addressed missing covariate data, and patient-clustered robust standard errors accounted for repeated admissions. The cohort included 11,277 hospital admissions from 10,789 patients; 195 admissions (1.73%) had the primary outcome. In the unadjusted model, higher PaO2 was associated with lower odds of the outcome (odds ratio [OR] per 10-mmHg increase, 0.970; 95% confidence interval [CI], 0.952-0.987), but this association attenuated after adjustment. In the fully adjusted model, PaO2 was not associated with the outcome (OR, 1.008; 95% CI, 0.989-1.027; P = 0.430). Most secondary analyses supported the primary result, although the 60-minute sensitivity analysis yielded adjustment-dependent estimates. In the complete cohort, a single early post-insertion PaO2 measurement was not independently associated with documented acute upper-body deep or central venous thrombosis. These findings do not support PaO2-based thrombosis risk stratification or modification of oxygen therapy for thrombosis prevention. Future studies should incorporate repeated oxygenation measurements and accurately timed, imaging-confirmed thrombotic outcomes.

ترجمه فارسی چکیده

نقص اکسیژن‌رسانی ممکن است بر ترومبوز تأثیر بگذارد، اما شواهد در بیماران بالینی دارای سوند هنوز محدود است. این مطالعه مشاهده‌ای بازگشت‌پذیر بررسی کرد که آیا اولین فشار جزئی اکسیژن آروار (PaO2) اندازه‌گیری شده در ۲۴ ساعت اول پس از ورود سوند واجد شرایط، با ترومبوز بالاتنه یا مرکزی حاد ثبت شده در حین بستری مرتبط است یا خیر. این مطالعه از پایگاه داده MIMIC-IV v2.2 (۲۰۰۸-۲۰۱۹) استفاده کرد. ۱۱،۲۷۷ بستری از ۱۰،۷۸۹ بیمار شامل شد. در مدل بدون تنظیم، PaO2 بالاتر با احتمال کمتر نتیجه مرتبط بود، اما این ارتباط پس از تنظیم کاهش یافت. در مدل کاملاً تنظیم شده، PaO2 با نتیجه مرتبط نبود. این یافته‌ها از رتبه‌بندی خطر ترومبوز بر اساس PaO2 یا تغییر درمان اکسیژن پشتیبانی نمی‌کنند.

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