To identify risk factors for internal jugular venous thrombosis in patients with lymphoma after real-time ultrasound-guided internal jugular vein catheterization (IJVC) to provide guidance for its clinical prevention and treatment.

The clinical and ultrasonic data of 108 patients with lymphoma who received ultrasound-guided IJVC at The First Affiliated Hospital of Nanjing Medical University from February 2021 to March 2023 were collected. Based on whether there was thrombosis in the internal jugular vein assessed by vascular ultrasound before operation, the patients were divided into two groups: non-thrombotic group (n=62) and thrombus group (n=46). Differences in clinical and ultrasonic characteristics between the two groups were compared by univariate analysis. Independent risk factors were identified by multivariate logistic regression. A risk prediction model was constructed based on the identified independent risk factors and high-risk factors, and the predictive efficacy of the model and each independent risk factor was quantified by using the area under the receiver operating characteristic (ROC) curve (AUC). Finally, a nomogram was constructed based on multivariate logistic regression models to visualize the prediction model, and its prediction accuracy was evaluated using a calibration curve. Clinical effectiveness of the nomogram was evaluated by decision curve analysis.

Univariate analysis demonstrated that the proportion of patients using 14G catheter (67.4% vs 30.6%) and single lumen tube (73.9% vs 46.8%), the levels of fibrinogen (FIB) [(3.36±1.01) g/L vs (2.80±0.75) g/L] and D-dimer [5.04 (3.49, 1.89) mg/L vs 0.18 (0.10, 0.58) mg/L], and the proportion of patients with aggressive lymphoma (91.3% vs 75.8%) and diabetes (93.5% vs 77.4%) were significantly higher, vascular diameter [10.6 (7.8, 14.1) mm vs 8.8 (7.5, 11.3) mm] was significantly larger, and activated partial thromboplastin time (APTT) [28.30 (26.08, 30.55) s vs 30.05 (27.60, 31.50) s] was significantly shorter in the thrombus group than in the non-thrombotic group (χ²=15.672, P=0.001; χ²=8.002, P=0.005; t=-3.328, P=0.001; Z=-3.483, P<0.001; χ²=4.375, P=0.036; χ²=5.135, P=0.023; Z=-2.262, P=0.024; Z=-2.206, P=0.027). Multivariate regression analysis showed that vascular diameter (odds ratio [OR]=1.175, 95% confidence interval [CI]: 1.016-1.358, P=0.029), FIB (OR=2.332, 95%CI: 1.185-4.590, P=0.014), and diabetes (OR=4.904, 95%CI: 1.017-23.652, P=0.048) were independently associated with thrombosis in lymphoma patients after ultrasound-guided IJVC (P<0.05 for all). The risk prediction model had an AUC of 0.831, sensitivity of 78.3%, specificity of 72.6%, and Yoden index of 0.509, providing better diagnostic efficacy than each independent risk factor. The nomogram model showed good fit in internal validation for predicting the risk of thrombosis in patients with lymphoma after ultrasound-guided IJVC.

Vascular diameter, FIB, and diabetes are independent risk factors for venous thrombosis after IJVC. The risk model established based on the above independent risk factors combined with APTT, catheter diameter, DD2, and lymphoma biological behavior, together with the general condition of lymphoma patients, can predict the risk of venous thrombosis before IJVC surgery, and provide guidance for clinical prevention and treatment of thrombosis.