Development and validation of a nomogram risk prediction model for PICC-related thrombosis in children with hematological malignancies

Background Early recognition and prevention are of great significance in reducing the incidence of Peripheral Intravenous Central Catheter (PICC)-related thrombosis. This study aimed to develop and validate a clinical risk prediction tool for PICC-related thrombosis in children with hematological malignancies. Methods Retrospectively selected children with hematological malignancies receiving PICC catheterization from January 2018 to December 2023 in Tongji Hospital as the study subjects and randomly divided into the training and validation sets according to the ratio of 7:3. A total of 54 possible predictor variables were collected from the hospital’s electronic medical record system and subjected to univariate and multivariate analyses. Logistic regression models were used to establish nomograms, which were evaluated by discrimination, calibration degree, and clinical applicability. Results 519 children were enrolled, of whom 98 (18.9%) were diagnosed with PICC-related thrombosis during retention. The final nomogram model incorporated six independent risk factors, including leukemia, number of catheters, history of catheterization, total parenteral nutrition, post-catheterization D-dimer, and post-catheterization fibrinogen. The area under the receiver operating characteristic curve was 0.844 (95% CI: 0.787 ~ 0.900) and 0.794 (95% CI: 0.698 ~ 0.890) for the training and validation sets, respectively, indicating that the model had good discrimination. All calibration curves showed that the model was well calibration degree. The decision curve analysis showed better net benefit of our model in predicting PICC-related thrombosis risk over a range of threshold probabilities from 5–87% and 91–97% in the training set, and from 4–85% in the validation set. Conclusions This nomogram model can be used as an effective tool to predict the risk of PICC-related thrombosis in children with hematological malignancies. It will facilitate pediatricians in early diagnosis, which is critical to reducing the incidence of PICC-related thrombosis.