Construction of a Risk Model for the Prevention of Catheter-Related Thrombosis by Positioning the Tip of Implantable Venous Infusion Port at the Superior Vena Cava-Right Atrial Junction under Real-Time Ultrasound Guidance: A Single-Center Retrospective Study in Adult Cancer Patients

Construction of a Risk Model for the Prevention of Catheter-Related Thrombosis by Positioning the Tip of Implantable Venous Infusion Port at the Superior Vena Cava-Right Atrial Junction under Real-Time Ultrasound Guidance: A Single-Center Retrospective Study in Adult Cancer Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Construction of a Risk Model for the Prevention of Catheter-Related Thrombosis by Positioning the Tip of Implantable Venous Infusion Port at the Superior Vena Cava-Right Atrial Junction under Real-Time Ultrasound Guidance: A Single-Center Retrospective Study in Adult Cancer Patients Quan Ling, Yinqi Yang, Junlin Wen, Jin Liu, Yong Chen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8576757/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective This study aimed to investigate the value of positioning the tip of implantable venous infusion ports (IVAPs) at the superior vena cava-right atrial junction (SVC-RAJ) under real-time ultrasound guidance for preventing catheter-related thrombosis (CRT), and to construct a risk prediction model based on multivariate logistic regression to provide evidence for precise clinical prevention and control. Methods Clinical data of adult cancer patients who received IVAP treatment at Zhongshan People's Hospital from June 2022 to June 2023 were retrospectively analyzed. Patients were divided into SVC-RAJ group and non-SVC-RAJ group according to the IVAP tip position, and the incidence of CRT was compared between the two groups. Independent risk factors for CRT were identified through multivariate logistic regression analysis, and a nomogram model was constructed. The model's performance was evaluated using receiver operating characteristic (ROC) curve analysis. Results The overall incidence of CRT was 30.33% (182/600). The CRT incidence in the SVC-RAJ group was 22.42%, significantly lower than the 38.73% in the non-SVC-RAJ group (P < 0.001). Univariate analysis showed that age, BMI, neutrophil-to-lymphocyte ratio (NLR), catheterization duration, tumor stage, D-dimer, prophylactic anticoagulation use, and tip position were associated with CRT occurrence (P < 0.05). Multivariate logistic regression analysis identified the following independent risk factors for CRT: age (OR = 1.050, 95% CI: 1.024–1.077, P < 0.05), BMI (OR = 1.187, 95% CI: 1.100–1.280, P < 0.05), tumor stage (OR = 2.096, 95% CI: 1.340–3.195, P < 0.05), NLR (OR = 1.489, 95% CI: 1.282–1.730, P < 0.05), D-dimer (OR = 4.280, 95% CI: 2.569–7.131, P < 0.05), catheterization duration (OR = 1.030, 95% CI: 1.020–1.039, P < 0.05), prophylactic anticoagulation status (OR = 1.884, 95% CI: 1.312–2.707, P < 0.05), and tip position (OR = 0.517, 95% CI: 0.353–0.756, P < 0.05). The area under the ROC curve (AUC) of the combined prediction model was 0.866 (95% CI: 0.837–0.895), with a sensitivity of 70.33%, specificity of 85.89%, and Youden index of 0.562, demonstrating good predictive performance. Conclusion Positioning the IVAP tip at the SVC-RAJ under real-time ultrasound guidance can significantly reduce the risk of CRT. The nomogram model constructed based on multiple factors demonstrates good predictive performance and can provide quantitative reference for individualized clinical prevention strategies. Implantable venous infusion port Catheter-related thrombosis Superior vena cava-right atrial junction Real-time ultrasound guidance Figures Figure 1 Figure 2 Figure 3 Figure 4 1.Introduction Implantable venous access ports (IVAPs) have become the preferred long-term venous infusion method in clinical practice for cancer patients undergoing chemotherapy, owing to their operational convenience, lower infection risk, and extended maintenance intervals. However, catheter-related thrombosis (CRT) remains one of the most common complications associated with IVAPs, with reported incidence rates ranging from 31.3% to 73.3%, significantly impacting treatment progression and patients' quality of life [ 1 ] . CRT not only potentially leads to catheter dysfunction and unplanned removal but may also precipitate life-threatening events such as pulmonary embolism, increasing healthcare costs and psychological burden on patients [ 2 ] . Consequently, exploring CRT prevention strategies and developing risk prediction models has emerged as a focal point of research in oncology supportive care. The pathophysiological mechanisms underlying CRT involve three key elements: vascular endothelial injury, hemodynamic alterations, and hypercoagulable states. Tumor cells can induce a thrombogenic microenvironment by secreting procoagulant factors (tissue factors), activating platelet aggregation, and compromising vascular endothelial integrity. Chemotherapeutic agents further exacerbate thrombotic risk by damaging vascular endothelial cells and inhibiting the synthesis of anticoagulant proteins [ 3 – 4 ] . Additionally, patient-specific factors (advanced age, obesity, inflammatory status) and catheter-related variables (catheter material, tip position, duration of catheterization) have been confirmed to correlate with CRT occurrence [ 5 ] . Among these, the optimal positioning of IVAP tips remains particularly contentious—traditional X-ray guidance typically places the tip in the mid-superior vena cava (SVC), but recent studies suggest that the superior vena cava-right atrial junction (SVC-RAJ) region, characterized by faster blood flow and reduced turbulence, may be more conducive to minimizing thrombus formation [ 6 ] . Real-time ultrasound-guided techniques have been progressively implemented in IVAP implantation procedures for vascular puncture and tip positioning due to their visualization advantages. Compared to conventional X-ray localization, ultrasound guidance enables dynamic monitoring of catheter trajectory, prevents vascular damage, and confirms tip positioning through intracavitary electrocardiography (ICE) or Doppler flow signals [ 7 ] . Research indicates [ 8 ] that ultrasound-guided SVC-RAJ positioning can enhance tip placement accuracy to over 92%, significantly reducing hemodynamic abnormalities caused by improper positioning. Nevertheless, substantial clinical evidence from large sample studies supporting the preventive effect of ultrasound-guided SVC-RAJ positioning on CRT remains limited. Concurrently, mathematical models have become essential tools for quantifying disease risk prediction [ 9 ] . Nomograms, as visualization models based on multivariate regression, can integrate multiple independent risk factors to provide individualized risk assessments for clinical application. Given these considerations, this single-center retrospective analysis aims to provide evidence-based guidance for precise prevention of IVAP-related CRT by incorporating real-time ultrasound-guided tip positioning as a modifiable risk factor into the model; integrating clinical indicators and procedural factors to construct a multidimensional risk prediction system; and systematically evaluating the clinical utility of the model through ROC curve analysis and Kappa tests, thereby establishing a foundation for subsequent multicenter research. 2. Materials and Methods 2.1 Patient Demographics This retrospective study included 600 adult cancer patients who underwent IVAP implantation at the Department of Medical Oncology, Zhongshan People's Hospital between June 2022 and June 2023. Data were extracted from the hospital's electronic medical record (EMR) system and vascular access management database, encompassing patient demographics, laboratory examinations, catheterization procedure records, and follow-up information. The study was approved by the Zhongshan People's Hospital's Ethics Committee (approval number: 2022-035-K037). Informed consent was waived due to the retrospective design, and data utilization adhered to the privacy protection principles outlined in the Declaration of Helsinki. Inclusion criteria: (1) Histopathologically confirmed malignancy requiring intravenous chemotherapy; (2) First-time IVAP implantation (models: B. Braun® Celsite® 7F or Bard® Port-a-Cath® 6.6F); (3) Post-procedural confirmation of IVAP tip position via anteroposterior chest X-ray (Philips DigitalDiagnost C90) and color Doppler ultrasonography (Philips EPIQ 7C, probe frequency 5–12 MHz); (4) Age ≥ 18 years with follow-up duration ≥ 3 months. Exclusion criteria (1) Concomitant hematological disorders (e.g., leukemia, lymphoma) or congenital coagulation dysfunction; (2) Previous history of deep vein thrombosis or pulmonary embolism; (3) Pre-implantation anticoagulation therapy (e.g., warfarin, low-molecular-weight heparin); (4) Incomplete clinical data (e.g., undocumented catheterization duration, incomplete ultrasound follow-up); (5) Pregnant or lactating women. 2.2 Grouping Criteria Patients were categorized into two groups based on IVAP tip position: (1) SVC-RAJ group (n = 223): Catheter tip positioned within 1–2 cm range of the superior vena cava-right atrial junction (measured by chest X-ray as the distance from the tip to the upper border of the right atrium, confirmed by ultrasound Doppler flow signals); (2) Non-SVC-RAJ group (n = 377): Catheter tip positioned in the mid-superior vena cava (> 2 cm from the upper border of the right atrium) or other locations such as the internal jugular vein. 2.3 CRT Diagnostic Criteria (1) Clinical manifestations included swelling, pain, infusion dysfunction, or elevated skin temperature in the catheterized limb [ 10 ] ; (2) Imaging confirmation required Doppler ultrasonography demonstrating solid echoes around or within the catheter lumen, non-compressible venous lumen under pressure, flow signal filling defects, or distal flow velocity < 10 cm/s [ 11 ] . Thrombus types were classified as fibrin sheath, mural deep vein thrombosis, or intraluminal catheter thrombosis [ 12 ] . The diagnostic algorithm prioritized ultrasound screening for suspected cases, followed by symptom-based grading for confirmation, with differential diagnosis from conditions such as phlebitis. Ultrasound examinations were independently interpreted by two physicians with ≥ 5 years of experience, with diagnosis confirmed when Kappa ≥ 0.85, ensuring diagnostic consistency. 2.4 Data Collection and Quality Control (1) Demographics and baseline characteristics : Age and gender: Extracted from patient identification information in the hospital information system (HIS), calculating age from birth date to catheterization date; gender information directly obtained from medical record front pages; double-verification between electronic and paper records with an error rate < 0.5%. Body Mass Index (BMI): Measured using SECA 813 electronic scales and SECA 213 height meters, calibrated weekly, with fasting weight and height measured pre-catheterization; calculated as weight (kg)/height (m)². Tumor type and staging: Tumor type determined from postoperative pathology reports or biopsy results; tumor staging based on AJCC 8th edition TNM classification [ 13 ] , assessed through imaging (CT/MRI) and pathological findings; pathology reports reviewed by two attending physicians, with staging discrepancies submitted to oncology multidisciplinary team (MDT) consultation [ 14 ] . (2) Laboratory parameters : Complete blood count (NLR, PLR): 2mL venous blood collected under fasting conditions within 72 hours pre-catheterization, EDTA-anticoagulated, analyzed using an automated hematology analyzer (Sysmex XN-9000) for neutrophil, lymphocyte, and platelet counts; NLR = neutrophil count/lymphocyte count; PLR = platelet count/lymphocyte count; daily calibration with internal quality control samples, CV < 5%; abnormal results verified by blood smear examination [ 15 ] . Coagulation profile (D-dimer, fibrinogen): 2mL venous blood collected under fasting conditions within 72 hours pre-catheterization, sodium citrate-anticoagulated; fibrinogen (FIB) measured by magnetic bead method (Stago STA-R Max), D-dimer by immunoturbidimetry; reference ranges: D-dimer < 0.5mg/L, FIB 2-4g/L; each batch tested with international standards (ISTH standard) [ 16 ] , inter-batch CV < 8%. Inflammatory markers (hs-CRP, TNF-α): 3mL venous blood collected under fasting conditions within 72 hours pre-catheterization, serum separated and stored at -80°C pending analysis; hs-CRP measured by immunoturbidimetry (Roche Cobas 8000), detection limit 0.02mg/L; TNF-α by ELISA (R&D Systems), detection range 3.12-200pg/mL; each plate included low, medium, and high concentration quality controls, recovery rate 90%-110%. (3) Catheterization-related factors : Access route, catheterization duration, catheter material (polyurethane/silicone), prophylactic anticoagulation use. (4) IVAP tip position (SVC-RAJ/non-SVC-RAJ) : Positioning method: Anteroposterior chest X-ray (Philips DigitalDiagnost C90, 80kV/200mA) performed within 24 hours post-procedure; vertical distance from catheter tip to upper border of right atrium measured (precision to 1mm); distance ≤ 20mm within the middle-lower 1/3 segment of SVC classified as SVC-RAJ group, otherwise as non-SVC-RAJ group; measurements independently performed by three radiologists, intraclass correlation coefficient (ICC) = 0.93 (95% CI 0.89–0.96), with remeasurement for differences > 2mm. CRT diagnosis: Ultrasound examination using Philips EPIQ 7C (5-12MHz linear array probe), with double-blind interpretation by two physicians with > 5 years of experience. 2.5 Statistical Analysis Data were analyzed using SPSS 26.0, Medcalc (V20.0.3), and GraphPad Prism 9 software. The Kolmogorov-Smirnov test was employed to verify normal distribution of quantitative data. Normally distributed quantitative data were expressed as mean ± standard deviation (x̄±s) and compared between groups using independent t-tests. Categorical data were presented as number (percentage) and analyzed using chi-square tests. Multivariate logistic regression analysis was performed on variables identified in univariate analysis, with regression coefficients (β), standard errors (SE), odds ratios (OR), and 95% confidence intervals (CI) recorded. Receiver operating characteristic (ROC) curves were utilized to assess diagnostic performance, with area under the curve (AUC), Youden index (YI), and 95% CI documented. 3.Results 3.1Comparison of Patient Baseline Characteristics As shown in Table 1 , a total of 600 patients were included in this study, with 223 patients in the SVC-RAJ group and 377 patients in the non-SVC-RAJ group. The two groups were well-balanced in terms of gender, tumor type, and other indicators. However, the non-SVC-RAJ group exhibited significantly higher values in age, BMI, and other parameters compared to the SVC-RAJ group (P < 0.05). Table 1 Comparison of patient baseline characteristics[ n (%)/༈ ༉] Project Classification SVC-RAJ(n = 223) Not SVC-RAJ(n = 377) t / χ 2 P Age (years) - 58.72 ± 10.21 62.39 ± 9.84 4.353 0.000 Gender Male 121 (51.93%) 210 (55.70%) 0.118 0.731 Female 102 (43.78%) 167 (44.30%) BMI (kg/m 2 ) - 23.89 ± 3.21 25.87 ± 3.56 6.825 0.000 Tumor Type Lung Cancer 82 (36.77%) 123 (32.63%) 2.550 0.279 Breast Cancer 69 (31.03%) 108 (28.65%) Others 72 (32.29%) 146 (38.73%) NLR - 2.81 ± 1.17 3.69 ± 1.45 7.700 0.000 ALB (g/L) - 41.32 ± 5.11 38.94 ± 4.82 5.715 0.000 Catheterization Time (d) - 42.63 ± 12.54 58.32 ± 15.71 12.709 0.000 Prophylactic Anticoagulation Yes 89 (39.91%) 108 (28.65%) 8.060 0.005 No 134 (57.51%) 269 (71.35%) 3.2 CRT Incidence and Univariate Analysis As demonstrated in Table 2 , among the 600 patients included in this study, 182 developed catheter-related thrombosis (CRT) postoperatively, yielding an overall incidence rate of 30.33%. The CRT incidence in the SVC-RAJ group was 22.42% (49/223), which was significantly lower than the 38.73% (146/377) observed in the non-SVC-RAJ group (χ²=23.56, P < 0.001). Univariate analysis revealed that age, BMI, neutrophil-to-lymphocyte ratio (NLR), catheterization duration, tumor stage, D-dimer levels, prophylactic anticoagulation use, and catheter tip position were significantly associated with CRT occurrence (P 0.05). Table 2 − 1: Demographics and Baseline Characteristics[( )/ n ༈%༉] Project Classification CRT(+)༈n = 182༉ CRT(-)༈n = 418༉ t / χ 2 P Age (years) - 61.30 ± 9.51 57.89 ± 10.27 3.822 0.000 Gender Male 102(56.04) 249(59.57) 0.649 0.420 Female 80(43.96) 169(40.43) BMI(kg/m 2 ) - 25.46 ± 3.73 23.57 ± 3.18 6.341 0.000 Tumor Type Lung Cancer 68(37.36) 137(32.78) 2.550 0.280 Breast Cancer 52(28.57) 110(26.32) Others 62(34.07) 171(40.91) Tumor staging Ⅰ-Ⅱ 32(17.58) 128(30.62) 11.024 0.001 Ⅲ-Ⅳ 150(82.42) 290(69.38) Table 2 2: Laboratory indicators( ) Project Classification CRT(+)༈n = 182༉ CRT(-)༈n = 418༉ t P Routine blood test NLR 3.51 ± 1.49 2.33 ± 1.96 7.259 0.000 PLR 158.41 ± 56.38 155.19 ± 52.39 0.676 0.499 Coagulation function,blood clotting function D- dimer(mg/L) 0.69 ± 0.31 0.42 ± 0.25 11.278 0.000 Dibrinogen(g/L) 4.21 ± 1.26 4.17 ± 1.11 0.389 0.697 Inflammatory factor hs-CRP(mg/L) 8.91 ± 6.11 7.96 ± 5.85 1.804 0.072 TNF-α(pg/mL) 38.53 ± 18.71 37.22 ± 16.39 0.861 0.389 Table 2 3: Catheter-related factors and IVAP tip position[ n (%)/༈ ༉] Project CRT(+)༈n = 182༉ CRT(-)༈n = 418༉ χ 2 / t P Route of catheterization Venae subclavia 112(61.54) 256(61.24) 0.005 0.946 Jugular vein,vena jugularis interna 70(38.46) 162(38.76) Time of catheter insertion 128.51 ± 32.15 108.75 ± 28.36 7.528 0.000 Catheter Material Polyurethane 105(57.69) 234(55.98) 0.151 0.697 Silica gel 77(42.31) 184(44.02) Prophylactic Anticoagulation Use Yes 78(42.86) 119(28.47) 11.903 0.001 No 104(57.14) 299(71.53) Tip Position of IVAP SVC-RAJ 49(26.92) 174(41.63) 11.738 0.001 Not SVC-RAJ 133(73.08) 244(58.37) 3.3 Logistic Regression Analysis of Risk Factors for CRT in IVAP Patients Using CRT diagnosis as the dependent variable, factors with P < 0.05 in univariate analysis (age, BMI, NLR, ALB, catheterization duration, tip position, and prophylactic anticoagulation status) were incorporated as independent variables into a logistic regression model. The results demonstrated that all aforementioned factors were independent risk factors for CRT development (P < 0.05). These findings are presented in Table 3 , Table 4 , Fig. 1 – 3 . Table 3 Variable assignment Variable Encoded Assignment method Dependent variable Confirmed cases of CRT Y CRT(+)= 1, CRT༈-༉= 0 Argument Age X1 Replace with the original value BMI X2 Replace with the original value Tumor_staging X3 Ⅰ-Ⅱ= 0, Ⅲ-Ⅳ= 1 NLR X4 Replace with the original value D-dimer X5 Replace with the original value Time of catheter insertion X6 Replace with the original value Preventive anticoagulation status X7 Yes = 1, No = 0 Top position X8 SVC-RAJ = 1, Not SVC-RAJ = 0 Table 4 Logistic regression analysis of risk factors for CRT risk in IVAP patients Influence Factor β SE Waldχ 2 P OR 95% CI Lower limit Upper limit Age 0.049 0.013 14.754 0.000 1.050 1.024 1.077 BMI 0.171 0.039 19.401 0.000 1.187 1.100 1.280 Tumor_staging 0.727 0.222 10.749 0.001 2.096 1.340 3.195 NLR 0.398 0.076 27.248 0.000 1.489 1.282 1.730 D-dimer 1.454 0.260 31.172 0.000 4.280 2.569 7.131 Time of catheter insertion 0.029 0.005 37.663 0.000 1.030 1.020 1.039 Preventive anticoagulation status 0.634 0.185 11.745 0.001 1.884 1.312 2.707 Top position -0.660 0.194 11.547 0.001 0.517 0.353 0.756 Note: β regression coefficient, SE standard error, OR odds ratio, 95%CI confidence interval. 3.4 ROC Curve Analysis of the Prediction Model Based on the regression coefficients, a prediction model was constructed: Logit (P) = β₁X₁ + β₂X₂ + β₃X₃ + ... (where P represents probability, X represents relevant influencing factors, and β represents the regression coefficient of the corresponding independent variable). The regression coefficients and odds ratios (ORs) for each variable were calculated. The resulting regression equation for the combined prediction model was: Age0.049 + BMI0.171 + Tumor stage0.727 + NLR0.398 + D-dimer1.454 + Catheterization duration0.029 + Prophylactic anticoagulation use0.634 + IVAP tip position-0.660. The prediction model was evaluated using receiver operating characteristic (ROC) curves, with calculation of the area under the curve (AUC) and 95% confidence intervals (CI). Results indicated that the combined prediction model demonstrated higher AUC values than any single parameter assessment. Detailed results are presented in Table 5 and Fig. 4. Table 5 ROC prediction value curve analysis of single and combined predictions of CRT risk in IVAP patients Influence Factor AUC YI P 95% CI Sensitivity (%) Specificity (%) Lower limit Upper limit Age 0.613 0.186 0.000 0.564 0.661 51.65 66.99 BMI 0.661 0.255 0.000 0.612 0.711 37.91 87.56 Tumor_staging 0.565 0.130 0.000 0.530 0.601 82.42 30.62 NLR 0.692 0.282 0.000 0.649 0.735 73.63 54.55 D-dimer 0.663 0.327 0.000 0.623 0.704 71.43 61.24 Time of catheter insertion 0.715 0.339 0.000 0.669 0.761 67.58 66.27 Preventive anticoagulation status 0.572 0.144 0.001 0.530 0.614 42.86 71.53 Top position 0.574 0.147 0.000 0.533 0.614 73.08 41.63 Joint projections 0.866 0.562 0.000 0.837 0.895 70.33 85.89 4. Discussion 4.1 Preventive Effect and Mechanism of SVC-RAJ Positioning on CRT This study confirms that real-time ultrasound-guided positioning of IVAP tips in the SVC-RAJ region significantly reduced CRT incidence to 22.42%, representing a 42.1% reduction compared to the 38.73% observed in the non-SVC-RAJ group (P < 0.001). This finding aligns with previous small-sample studies demonstrating ultrasound-guided positioning accuracy exceeding 92% [ 17 ] . From a hemodynamic perspective, the SVC-RAJ region experiences blood flow velocities of 10–15 cm/s due to right atrial contractile flushing, significantly higher than the 5–8 cm/s observed in the mid-SVC region. This high-velocity flow reduces the temporal window for fibrin sheath deposition on catheter surfaces [ 18 ] . Additionally, this region maintains a relatively constant vessel diameter (18–22 mm), minimizing catheter-vessel wall contact area and thereby reducing the risk of mechanical endothelial injury [ 19 – 20 ] . Notably, although the SVC-RAJ group demonstrated lower baseline indicators for age and BMI compared to the non-SVC-RAJ group, multivariate regression analysis confirmed that tip position remained an independent protective factor (OR = 0.517, 95% CI: 0.353–0.756), suggesting that positioning strategy's clinical value persists regardless of patient baseline characteristics. Compared with traditional X-ray positioning, real-time ultrasound guidance offers superior three-dimensional dynamic monitoring capabilities. The intracardiac electrocardiogram (ICE) combined with Doppler flow signal confirmation technique employed in this study enables real-time verification of tip position during catheterization, avoiding measurement errors due to respiratory movement (average error approximately 3–5 mm) common in X-ray positioning [ 21 ] . Precise ultrasound-guided positioning also reduces the frequency of catheter readjustments [ 22 ] . In our study, the mean catheterization duration in the SVC-RAJ group was 15.69 days shorter than in the non-SVC-RAJ group (P < 0.05), potentially further reducing thrombosis risk by minimizing repeated endothelial injury. 4.2 Clinical Significance of Independent Risk Factors for CRT Multivariate logistic regression analysis identified eight independent risk factors for CRT, including age, BMI, and tumor stage. D-dimer demonstrated the highest OR at 4.280 (95% CI: 2.569–7.131), suggesting that coagulation activation represents the core driving factor in CRT development. This aligns with Virchow's triad (blood stasis, endothelial injury, and hypercoagulability) commonly observed in cancer patients [ 23 ] . As a fibrin degradation product, elevated D-dimer levels reflect excessive activation of the coagulation-fibrinolysis system and serve as a sensitive biomarker for predicting CRT [ 24 – 25 ] . Patients with stage III-IV tumors exhibited 2.096 times higher CRT risk compared to those with stage I-II disease, potentially related to increased tissue factor (TF) secretion in advanced malignancies. TF activates the extrinsic coagulation pathway, forming procoagulant networks in the tumor microenvironment. Advanced-stage patients also typically experience more severe inflammatory responses [ 26 – 27 ] . Elevated neutrophil-to-lymphocyte ratio reflects immune-coagulation axis dysregulation [ 28 – 29 ] , with each unit increase in NLR associated with a 48.9% increased CRT risk (OR = 1.489). Notably, prophylactic anticoagulation appeared as a risk factor (OR = 1.884), contradicting clinical intuition. Deeper analysis suggests indication bias—clinicians likely prescribed anticoagulants preferentially to high-risk patients (elevated D-dimer, advanced malignancy), resulting in an anticoagulation group inherently predisposed to CRT. This highlights the importance of risk model-based anticoagulation decisions rather than relying on single indicators [ 30 ] . 4.3 Predictive Performance and Clinical Application of the Nomogram Model The combined prediction model developed in this study achieved an AUC of 0.866 (95% CI: 0.837–0.895), with sensitivity of 70.33%, specificity of 85.89%, and Youden index of 0.562, demonstrating excellent clinical utility. Unlike single-parameter assessments, this model integrates hemodynamic factors (tip position), systemic status (age, BMI), tumor burden (staging), coagulation function (D-dimer), and procedural factors (catheterization duration) to create a multidimensional risk assessment system. The Hosmer-Lemeshow test (P = 0.843) indicates good agreement between predicted and observed values, with the calibration curve showing less than 5% deviation between predicted probabilities and actual risk. The nomogram's visualization advantage provides a quantitative tool for clinical decision-making. For example, a 60-year-old patient with BMI 25 kg/m², stage III lung cancer, NLR 3.5, D-dimer 0.7 mg/L, catheterization duration of 60 days, no prophylactic anticoagulation, and catheter tip positioned outside the SVC-RAJ region would score approximately 220 points, corresponding to a 78.6% CRT risk probability. This indicates the need for enhanced preventive measures (e.g., ultrasound-guided catheter repositioning, therapeutic anticoagulation). This individualized assessment approach avoids "one-size-fits-all" prevention strategies. In our cohort, using a model-predicted risk threshold of ≥ 50% as indication for anticoagulation would optimize prophylactic anticoagulation usage from 31.17% to 45.3%, while maintaining CRT missed diagnosis rates below 12.7%. 5. Conclusion We recommend routine implementation of real-time ultrasound-guided techniques for IVAP implantation in cancer patients, with SVC-RAJ positioning (1–2 cm above the right atrium junction) as the standard approach. For elderly patients (> 65 years), those with high BMI (> 28 kg/m²), advanced-stage malignancies (stages III-IV), NLR > 3.0, or D-dimer > 0.5 mg/L, pre-catheterization CRT risk assessment using the nomogram model is advisable. High-risk patients may benefit from prophylactic low-molecular-weight heparin (enoxaparin 40 mg daily) and shortened ultrasound follow-up intervals (biweekly). Future research should focus on: (1) conducting multicenter prospective studies to validate the model's predictive performance across different cancer types; (2) exploring correlations between ultrasound-guided dynamic flow parameters (peak velocity, turbulence index) and CRT to enhance mechanistic understanding; and (3) developing molecular marker panels incorporating liquid biopsy (circulating tumor cells, extracellular vesicles) to improve model prediction accuracy. This multimodal risk assessment system integrating imaging, clinical indicators, and molecular biology will establish new pathways for precise CRT prevention and control. Declarations Ethics approval and consent to participate The study was approved by the Zhongshan People's Hospital 's Ethics Committee (approval number: 2022-035-K037). Informed consent was waived due to the retrospective design, and data utilization adhered to the privacy protection principles outlined in the Declaration of Helsinki. Competing interests The authors declare no competing interests. Funding This work was supported by Guangdong Medical Science and Technology Research Fund Project, A2022336; Zhongshan social welfare science and technology research project, 2022B1101. Author Contribution Conceptualization, QL and YC; methodology, YY; software, JW; validation, JW; formal analysis, JL and QL; investigation, JW and JL; resources, YY; data curation, YY; writing—original draft preparation, QL; writing—review and editing, YC; visualization, YY; supervision, JL; project administration, YC; funding acquisition, YC. All authors have read and agreed to the published version of the manuscript. Data Availability The datasets generated and analysed during the current study are not publicly available due to a further study of this area but are available from the corresponding author on reasonable request. References Zhang X, Geng C. Unsuccessful removal of a totally implantable venous access port caused by thrombosis in the left brachiocephalic vein: A case report. Medicine. 2019;98(13):14985. Tian L, Feng X, Luo Hetal. Evidence-based summary of preventive care for central venous access device-related thrombosis in hospitalized children. BMC Nurs. 2024;23(1):664. Grover SP, Hisada YM, Kasthuri RS et al. (2021). Cancer Therapy-Associated Thrombosis. Arteriosclerosis, thrombosis, and vascular biology, 41(4), 1291–1305. Li S, Lu Z, Wu S, et al. The dynamic role of platelets in cancer progression and their therapeutic implications. Nat Rev Cancer. 2024;24(1):72–87. Tian L, Feng X, Luo H, et al. Evidence-based summary of preventive care for central venous access device-related thrombosis in hospitalized children. BMC Nurs. 2024;23(1):664. Deng XB, Peng L, Zhang Jetal. (2023). Dual ultrasound-guided totally implantable venous access ports via the right internal jugular vein in pediatric patients with cancer: a preliminary experience in a single institution. World J Pediatr Surg, 6(3), e000509. Greca A, Iacobone E, Elisei D, et al. ECHOTIP: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in adult patients. J Vasc Access. 2023;24(4):535–44. Chapela SP, Descotte EJ, Reberendo MJ. Nasoenteric tube doppler guided insertion. A case report and review of literature. Eur J Clin Nutr. 2022;76(6):907–9. Mack V, Nißler D, Kasikci D, et al. Magnetic Tracking and Electrocardiography-Guided Tip Confirmation System Versus Fluoroscopy for Placement of Peripherally Inserted Central Catheters: A Randomized, Noninferiority Comparison. Cardiovasc Interv Radiol. 2020;43(12):1891–7. Farge D, Frere C, Connors JM, International Initiative on Thrombosis and Cancer (ITAC) advisory panel. 2022 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer, including patients with COVID-19. Lancet Oncol. 2022;23(7):e334–47. Carrier M, Blais N, Crowther M et al. (2021). Treatment Algorithm in Cancer-Associated Thrombosis: Updated Canadian Expert Consensus. Current oncology (Toronto, Ont.), 28(6), 5434–51. Ortel TL, Neumann I, Ageno Wetal. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv. 2020;4(19):4693–738. Escrig Sos J, Gómez Quiles L, Maiocchi K. The 8th edition of the AJCC-TNM classification: New contributions to the staging of esophagogastric junction cancer. La 8.ª edición de la clasificación AJCC-TNM: nuevas aportaciones a la estadificación del cáncer de la unión esofagogástrica. Cir Esp. 2019;97(8):432–7. Bedrikovetski S, Dudi-Venkata NN, Kroon HM, et al. A prospective study of diagnostic accuracy of multidisciplinary team and radiology reporting of preoperative colorectal cancer local staging. Asia-Pac J Clin Oncol. 2023;19(1):206–13. Wang RH, Wen WX, Jiang ZP, et al. The clinical value of neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR) and systemic inflammation response index (SIRI) for predicting the occurrence and severity of pneumonia in patients with intracerebral hemorrhage. Front Immunol. 2023;14:1115031. Espitia O, Tissot A, Miossec A, et al. Upper extremity venous thrombosis in hospitalized patients: A prospective epidemiological study. Thromb Res. 2024;233:174–80. Ding W, Qiu L, Li T et al. (2022). Ultrasound-guided totally implantable venous access ports placement via right brachiocephalic vein in pediatric population: A clinical debut. Pediatr Blood Cancer, 69(10), e29911. Corley A, Royle RH, Marsh Netal. Incidence and risk factors for central venous access device failure in hospitalized adults: A multivariable analysis of 1892 catheters. J Hosp Med. 2024;19(10):905–17. Luo H, Jin C, Li X et al. (2023). Quantified versus willful handgrip exercises for the prevention of PICC-related thrombosis: A meta-analysis and systematic review. Medicine, 102(10), e32706. Bu X, Wu X. Analysis of the preventive effect of upper limb exercise combined with intelligent grip ball on venous thrombosis in patients with peripheral central venous catheters. Am J translational Res. 2024;16(11):6709–17. Shi J, Shen J, Xiang Z, et al. Dynamic Needle Tip Positioning versus Palpation and Ultrasound for Arteriovenous Puncture: A Meta-analysis. Ultrasound Med Biol. 2021;47(8):2233–42. Munshey F, Parra DA, McDonnell C, et al. Ultrasound-guided techniques for peripheral intravenous placement in children with difficult venous access. Paediatr Anaesth. 2020;30(2):108–15. Viale PH, Schwartz RN. Venous thromboembolism in patients with cancer. Part II. Current treatment strategies. Clin J Oncol Nurs. 2004;8(5):465–9. Kaul P, Tiwari AR, Kaul P, et al. Revisiting the Anatomical Landmark-Guided Central Venous Access Device Insertion: A Retrospective Cohort Study. World J Surg. 2023;47(10):2562–7. Liao SC, Shao SC, Gao S, et al. Augmented reality visualization for ultrasound-guided interventions: a pilot randomized crossover trial to assess trainee performance and cognitive load. BMC Med Educ. 2024;24(1):1058. Fellhofer-Hofer J, Franz C, Vey JA, et al. Chemokines as Prognostic Factor in Colorectal Cancer Patients: A Systematic Review and Meta-Analysis. Int J Mol Sci. 2024;25(10):5374. Vageli DP, Doukas PG, Goupou Ketal. Hypoxia-inducible factor 1alpha and vascular endothelial growth factor in Glioblastoma Multiforme: a systematic review going beyond pathologic implications. Oncol Res. 2024;32(8):1239–56. Naik A, Adeleye O, Koester S, et al. Cerebrospinal Fluid Biomarkers for Diagnosis and the Prognostication of Acute Ischemic Stroke: A Systematic Review. Int J Mol Sci. 2023;24(13):10902. Veitch AM, Radaelli F, Alikhan R. Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update. Gut. 2021;70(9):1611–28. Abraham NS, Barkun AN, Sauer BG, et al. American College of Gastroenterology-Canadian Association of Gastroenterology Clinical Practice Guideline: Management of Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Periendoscopic Period. Am J Gastroenterol. 2022;117(4):542–58. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8576757","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":587013613,"identity":"ccb96e0b-5ba1-4dfb-9da9-fa5e1cfe6bc6","order_by":0,"name":"Quan Ling","email":"","orcid":"","institution":"Zhongshan People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Quan","middleName":"","lastName":"Ling","suffix":""},{"id":587013614,"identity":"772040a3-08b7-45e9-a1b0-be4832fb6737","order_by":1,"name":"Yinqi Yang","email":"","orcid":"","institution":"Zhongshan People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yinqi","middleName":"","lastName":"Yang","suffix":""},{"id":587013615,"identity":"9b85e687-4fd7-45f2-a34c-cb6fc6d078f9","order_by":2,"name":"Junlin Wen","email":"","orcid":"","institution":"Zhongshan People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Junlin","middleName":"","lastName":"Wen","suffix":""},{"id":587013616,"identity":"aed946d5-35dd-41a0-8a7e-2d71f092981f","order_by":3,"name":"Jin Liu","email":"","orcid":"","institution":"Zhongshan People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jin","middleName":"","lastName":"Liu","suffix":""},{"id":587013617,"identity":"b215a6a7-4e14-4dfc-a929-6bac175448e8","order_by":4,"name":"Yong Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYBACgwMgsgZIsjc3SACZjA3EaTkGJHkOEqlFEqSCsQmoRSKRSC387L2HXzA23JEzl3zYeJuHwUZ2wwHexx/waWHjOZdmwdjwzNhydmKzNQ9DmvGGA+xmEni1SOSYGf9tOJy44XZimzQPA5BxgI0Nr8NAWgwYGw7Xb7h5EKTlP0gLM36HSeQYP2BsOpxgcIMRpOUASAsDfofxnDEDBvJhww1nEpst5xgkG888zMaGXwt7j/EHhprD8gbHDx+88abCTrbveBt+h4HdBmMx8RgASWYC6kFK4GYy/iCsehSMglEwCkYgAADbukyQLgB16AAAAABJRU5ErkJggg==","orcid":"","institution":"Zhongshan People's Hospital","correspondingAuthor":true,"prefix":"","firstName":"Yong","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2026-01-12 03:08:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8576757/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8576757/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102297216,"identity":"0a709349-0fa3-40a1-99f8-913504ae14b8","added_by":"auto","created_at":"2026-02-10 10:26:31","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":68902,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePrediction of CRT line chart of related independent risk factors\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8576757/v1/855a9d76bee85b2c252a87ef.jpeg"},{"id":102212391,"identity":"fa8b8fa9-290f-4d3a-977a-3a29ad83e10e","added_by":"auto","created_at":"2026-02-09 12:32:37","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":35927,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDCA validation curve of the prediction model for CRT risk in IVAP\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8576757/v1/97e81b00cc432da4d286907a.jpeg"},{"id":102212389,"identity":"c33c83e4-e931-4f93-a395-2fb06518624f","added_by":"auto","created_at":"2026-02-09 12:32:37","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":57565,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCalibration curve of CRT risk prediction model for IVAP patients\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8576757/v1/518f7e67bfe75fa94a04cc62.jpeg"},{"id":102212390,"identity":"6e1ff4c6-a389-441c-995a-c231e9133e55","added_by":"auto","created_at":"2026-02-09 12:32:37","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":129177,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eROC curves of single prediction and joint prediction\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8576757/v1/4cce2cbe3f2d054547ff93d3.jpg"},{"id":104405329,"identity":"7ec1e333-0c10-4870-a0b8-4ac390baed04","added_by":"auto","created_at":"2026-03-11 12:22:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1559946,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8576757/v1/c9fb8b0e-e946-47ec-8021-1471d547f9de.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Construction of a Risk Model for the Prevention of Catheter-Related Thrombosis by Positioning the Tip of Implantable Venous Infusion Port at the Superior Vena Cava-Right Atrial Junction under Real-Time Ultrasound Guidance: A Single-Center Retrospective Study in Adult Cancer Patients","fulltext":[{"header":"1.Introduction","content":"\u003cp\u003eImplantable venous access ports (IVAPs) have become the preferred long-term venous infusion method in clinical practice for cancer patients undergoing chemotherapy, owing to their operational convenience, lower infection risk, and extended maintenance intervals. However, catheter-related thrombosis (CRT) remains one of the most common complications associated with IVAPs, with reported incidence rates ranging from 31.3% to 73.3%, significantly impacting treatment progression and patients' quality of life\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. CRT not only potentially leads to catheter dysfunction and unplanned removal but may also precipitate life-threatening events such as pulmonary embolism, increasing healthcare costs and psychological burden on patients\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Consequently, exploring CRT prevention strategies and developing risk prediction models has emerged as a focal point of research in oncology supportive care.\u003c/p\u003e \u003cp\u003eThe pathophysiological mechanisms underlying CRT involve three key elements: vascular endothelial injury, hemodynamic alterations, and hypercoagulable states. Tumor cells can induce a thrombogenic microenvironment by secreting procoagulant factors (tissue factors), activating platelet aggregation, and compromising vascular endothelial integrity. Chemotherapeutic agents further exacerbate thrombotic risk by damaging vascular endothelial cells and inhibiting the synthesis of anticoagulant proteins\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Additionally, patient-specific factors (advanced age, obesity, inflammatory status) and catheter-related variables (catheter material, tip position, duration of catheterization) have been confirmed to correlate with CRT occurrence\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Among these, the optimal positioning of IVAP tips remains particularly contentious\u0026mdash;traditional X-ray guidance typically places the tip in the mid-superior vena cava (SVC), but recent studies suggest that the superior vena cava-right atrial junction (SVC-RAJ) region, characterized by faster blood flow and reduced turbulence, may be more conducive to minimizing thrombus formation\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eReal-time ultrasound-guided techniques have been progressively implemented in IVAP implantation procedures for vascular puncture and tip positioning due to their visualization advantages. Compared to conventional X-ray localization, ultrasound guidance enables dynamic monitoring of catheter trajectory, prevents vascular damage, and confirms tip positioning through intracavitary electrocardiography (ICE) or Doppler flow signals\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Research indicates\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e that ultrasound-guided SVC-RAJ positioning can enhance tip placement accuracy to over 92%, significantly reducing hemodynamic abnormalities caused by improper positioning. Nevertheless, substantial clinical evidence from large sample studies supporting the preventive effect of ultrasound-guided SVC-RAJ positioning on CRT remains limited. Concurrently, mathematical models have become essential tools for quantifying disease risk prediction\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Nomograms, as visualization models based on multivariate regression, can integrate multiple independent risk factors to provide individualized risk assessments for clinical application.\u003c/p\u003e \u003cp\u003eGiven these considerations, this single-center retrospective analysis aims to provide evidence-based guidance for precise prevention of IVAP-related CRT by incorporating real-time ultrasound-guided tip positioning as a modifiable risk factor into the model; integrating clinical indicators and procedural factors to construct a multidimensional risk prediction system; and systematically evaluating the clinical utility of the model through ROC curve analysis and Kappa tests, thereby establishing a foundation for subsequent multicenter research.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Patient Demographics\u003c/h2\u003e \u003cp\u003eThis retrospective study included 600 adult cancer patients who underwent IVAP implantation at the Department of Medical Oncology, Zhongshan People's Hospital between June 2022 and June 2023. Data were extracted from the hospital's electronic medical record (EMR) system and vascular access management database, encompassing patient demographics, laboratory examinations, catheterization procedure records, and follow-up information. The study was approved by the Zhongshan People's Hospital's Ethics Committee (approval number: 2022-035-K037). Informed consent was waived due to the retrospective design, and data utilization adhered to the privacy protection principles outlined in the Declaration of Helsinki.\u003c/p\u003e \u003cp\u003eInclusion criteria: (1) Histopathologically confirmed malignancy requiring intravenous chemotherapy; (2) First-time IVAP implantation (models: B. Braun\u0026reg; Celsite\u0026reg; 7F or Bard\u0026reg; Port-a-Cath\u0026reg; 6.6F); (3) Post-procedural confirmation of IVAP tip position via anteroposterior chest X-ray (Philips DigitalDiagnost C90) and color Doppler ultrasonography (Philips EPIQ 7C, probe frequency 5\u0026ndash;12 MHz); (4) Age\u0026thinsp;\u0026ge;\u0026thinsp;18 years with follow-up duration\u0026thinsp;\u0026ge;\u0026thinsp;3 months.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eExclusion criteria\u003c/strong\u003e \u003cp\u003e(1) Concomitant hematological disorders (e.g., leukemia, lymphoma) or congenital coagulation dysfunction; (2) Previous history of deep vein thrombosis or pulmonary embolism; (3) Pre-implantation anticoagulation therapy (e.g., warfarin, low-molecular-weight heparin); (4) Incomplete clinical data (e.g., undocumented catheterization duration, incomplete ultrasound follow-up); (5) Pregnant or lactating women.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Grouping Criteria\u003c/h2\u003e \u003cp\u003ePatients were categorized into two groups based on IVAP tip position:\u003c/p\u003e \u003cp\u003e(1) SVC-RAJ group (n\u0026thinsp;=\u0026thinsp;223): Catheter tip positioned within 1\u0026ndash;2 cm range of the superior vena cava-right atrial junction (measured by chest X-ray as the distance from the tip to the upper border of the right atrium, confirmed by ultrasound Doppler flow signals);\u003c/p\u003e \u003cp\u003e(2) Non-SVC-RAJ group (n\u0026thinsp;=\u0026thinsp;377): Catheter tip positioned in the mid-superior vena cava (\u0026gt;\u0026thinsp;2 cm from the upper border of the right atrium) or other locations such as the internal jugular vein.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 CRT Diagnostic Criteria\u003c/h2\u003e \u003cp\u003e(1) Clinical manifestations included swelling, pain, infusion dysfunction, or elevated skin temperature in the catheterized limb\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e; (2) Imaging confirmation required Doppler ultrasonography demonstrating solid echoes around or within the catheter lumen, non-compressible venous lumen under pressure, flow signal filling defects, or distal flow velocity\u0026thinsp;\u0026lt;\u0026thinsp;10 cm/s\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Thrombus types were classified as fibrin sheath, mural deep vein thrombosis, or intraluminal catheter thrombosis\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. The diagnostic algorithm prioritized ultrasound screening for suspected cases, followed by symptom-based grading for confirmation, with differential diagnosis from conditions such as phlebitis. Ultrasound examinations were independently interpreted by two physicians with \u0026ge;\u0026thinsp;5 years of experience, with diagnosis confirmed when Kappa\u0026thinsp;\u0026ge;\u0026thinsp;0.85, ensuring diagnostic consistency.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Data Collection and Quality Control\u003c/h2\u003e \u003cp\u003e(1) \u003cb\u003eDemographics and baseline characteristics\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eAge and gender: Extracted from patient identification information in the hospital information system (HIS), calculating age from birth date to catheterization date; gender information directly obtained from medical record front pages; double-verification between electronic and paper records with an error rate\u0026thinsp;\u0026lt;\u0026thinsp;0.5%.\u003c/p\u003e \u003cp\u003eBody Mass Index (BMI): Measured using SECA 813 electronic scales and SECA 213 height meters, calibrated weekly, with fasting weight and height measured pre-catheterization; calculated as weight (kg)/height (m)\u0026sup2;.\u003c/p\u003e \u003cp\u003eTumor type and staging: Tumor type determined from postoperative pathology reports or biopsy results; tumor staging based on AJCC 8th edition TNM classification\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e, assessed through imaging (CT/MRI) and pathological findings; pathology reports reviewed by two attending physicians, with staging discrepancies submitted to oncology multidisciplinary team (MDT) consultation\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e(2) \u003cb\u003eLaboratory parameters\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eComplete blood count (NLR, PLR): 2mL venous blood collected under fasting conditions within 72 hours pre-catheterization, EDTA-anticoagulated, analyzed using an automated hematology analyzer (Sysmex XN-9000) for neutrophil, lymphocyte, and platelet counts; NLR\u0026thinsp;=\u0026thinsp;neutrophil count/lymphocyte count; PLR\u0026thinsp;=\u0026thinsp;platelet count/lymphocyte count; daily calibration with internal quality control samples, CV\u0026thinsp;\u0026lt;\u0026thinsp;5%; abnormal results verified by blood smear examination\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eCoagulation profile (D-dimer, fibrinogen): 2mL venous blood collected under fasting conditions within 72 hours pre-catheterization, sodium citrate-anticoagulated; fibrinogen (FIB) measured by magnetic bead method (Stago STA-R Max), D-dimer by immunoturbidimetry; reference ranges: D-dimer\u0026thinsp;\u0026lt;\u0026thinsp;0.5mg/L, FIB 2-4g/L; each batch tested with international standards (ISTH standard)\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e, inter-batch CV\u0026thinsp;\u0026lt;\u0026thinsp;8%.\u003c/p\u003e \u003cp\u003eInflammatory markers (hs-CRP, TNF-α): 3mL venous blood collected under fasting conditions within 72 hours pre-catheterization, serum separated and stored at -80\u0026deg;C pending analysis; hs-CRP measured by immunoturbidimetry (Roche Cobas 8000), detection limit 0.02mg/L; TNF-α by ELISA (R\u0026amp;D Systems), detection range 3.12-200pg/mL; each plate included low, medium, and high concentration quality controls, recovery rate 90%-110%.\u003c/p\u003e \u003cp\u003e(3) \u003cb\u003eCatheterization-related factors\u003c/b\u003e: Access route, catheterization duration, catheter material (polyurethane/silicone), prophylactic anticoagulation use.\u003c/p\u003e \u003cp\u003e(4) \u003cb\u003eIVAP tip position (SVC-RAJ/non-SVC-RAJ)\u003c/b\u003e:\u003c/p\u003e \u003cp\u003ePositioning method: Anteroposterior chest X-ray (Philips DigitalDiagnost C90, 80kV/200mA) performed within 24 hours post-procedure; vertical distance from catheter tip to upper border of right atrium measured (precision to 1mm); distance\u0026thinsp;\u0026le;\u0026thinsp;20mm within the middle-lower 1/3 segment of SVC classified as SVC-RAJ group, otherwise as non-SVC-RAJ group; measurements independently performed by three radiologists, intraclass correlation coefficient (ICC)\u0026thinsp;=\u0026thinsp;0.93 (95% CI 0.89\u0026ndash;0.96), with remeasurement for differences\u0026thinsp;\u0026gt;\u0026thinsp;2mm.\u003c/p\u003e \u003cp\u003eCRT diagnosis: Ultrasound examination using Philips EPIQ 7C (5-12MHz linear array probe), with double-blind interpretation by two physicians with \u0026gt;\u0026thinsp;5 years of experience.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Statistical Analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using SPSS 26.0, Medcalc (V20.0.3), and GraphPad Prism 9 software. The Kolmogorov-Smirnov test was employed to verify normal distribution of quantitative data. Normally distributed quantitative data were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (x̄\u0026plusmn;s) and compared between groups using independent t-tests. Categorical data were presented as number (percentage) and analyzed using chi-square tests. Multivariate logistic regression analysis was performed on variables identified in univariate analysis, with regression coefficients (β), standard errors (SE), odds ratios (OR), and 95% confidence intervals (CI) recorded. Receiver operating characteristic (ROC) curves were utilized to assess diagnostic performance, with area under the curve (AUC), Youden index (YI), and 95% CI documented.\u003c/p\u003e \u003c/div\u003e"},{"header":"3.Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.1Comparison of Patient Baseline Characteristics\u003c/h2\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, a total of 600 patients were included in this study, with 223 patients in the SVC-RAJ group and 377 patients in the non-SVC-RAJ group. The two groups were well-balanced in terms of gender, tumor type, and other indicators. However, the non-SVC-RAJ group exhibited significantly higher values in age, BMI, and other parameters compared to the SVC-RAJ group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of patient baseline characteristics[\u003cem\u003en\u003c/em\u003e(%)/༈\u003cspan class=\"InlineEquation\"\u003e\u003c/span\u003e༉]\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProject\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClassification\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSVC-RAJ(n\u0026thinsp;=\u0026thinsp;223)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot SVC-RAJ(n\u0026thinsp;=\u0026thinsp;377)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e/\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.72\u0026thinsp;\u0026plusmn;\u0026thinsp;10.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.39\u0026thinsp;\u0026plusmn;\u0026thinsp;9.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.353\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e121 (51.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e210 (55.70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.731\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102 (43.78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e167 (44.30%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.89\u0026thinsp;\u0026plusmn;\u0026thinsp;3.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.87\u0026thinsp;\u0026plusmn;\u0026thinsp;3.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.825\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTumor Type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLung Cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82 (36.77%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e123 (32.63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2.550\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.279\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBreast Cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (31.03%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e108 (28.65%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (32.29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e146 (38.73%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.81\u0026thinsp;\u0026plusmn;\u0026thinsp;1.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.69\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALB (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.32\u0026thinsp;\u0026plusmn;\u0026thinsp;5.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.94\u0026thinsp;\u0026plusmn;\u0026thinsp;4.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.715\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCatheterization Time (d)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.63\u0026thinsp;\u0026plusmn;\u0026thinsp;12.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58.32\u0026thinsp;\u0026plusmn;\u0026thinsp;15.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12.709\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eProphylactic Anticoagulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89 (39.91%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e108 (28.65%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e8.060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e134 (57.51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e269 (71.35%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.2 CRT Incidence and Univariate Analysis\u003c/h2\u003e \u003cp\u003eAs demonstrated in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e2\u003c/span\u003e, among the 600 patients included in this study, 182 developed catheter-related thrombosis (CRT) postoperatively, yielding an overall incidence rate of 30.33%. The CRT incidence in the SVC-RAJ group was 22.42% (49/223), which was significantly lower than the 38.73% (146/377) observed in the non-SVC-RAJ group (χ\u0026sup2;=23.56, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Univariate analysis revealed that age, BMI, neutrophil-to-lymphocyte ratio (NLR), catheterization duration, tumor stage, D-dimer levels, prophylactic anticoagulation use, and catheter tip position were significantly associated with CRT occurrence (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The remaining parameters demonstrated no statistical significance (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026thinsp;\u0026minus;\u0026thinsp;1: Demographics and Baseline Characteristics[(\u003cspan class=\"InlineEquation\"\u003e\u003c/span\u003e)/\u003cem\u003en\u003c/em\u003e༈%༉]\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProject\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClassification\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCRT(+)༈n\u0026thinsp;=\u0026thinsp;182༉\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCRT(-)༈n\u0026thinsp;=\u0026thinsp;418༉\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e/\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.30\u0026thinsp;\u0026plusmn;\u0026thinsp;9.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.89\u0026thinsp;\u0026plusmn;\u0026thinsp;10.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.822\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102(56.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e249(59.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.649\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.420\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80(43.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e169(40.43)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI(kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.46\u0026thinsp;\u0026plusmn;\u0026thinsp;3.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.57\u0026thinsp;\u0026plusmn;\u0026thinsp;3.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.341\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTumor Type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLung Cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68(37.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e137(32.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2.550\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.280\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBreast Cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52(28.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e110(26.32)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62(34.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e171(40.91)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTumor staging\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eⅠ-Ⅱ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32(17.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e128(30.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e11.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eⅢ-Ⅳ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e150(82.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e290(69.38)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e2: Laboratory indicators(\u003cspan class=\"InlineEquation\"\u003e\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProject\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClassification\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCRT(+)༈n\u0026thinsp;=\u0026thinsp;182༉\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCRT(-)༈n\u0026thinsp;=\u0026thinsp;418༉\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRoutine blood test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e2.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.259\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e158.41\u0026thinsp;\u0026plusmn;\u0026thinsp;56.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e155.19\u0026thinsp;\u0026plusmn;\u0026thinsp;52.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.676\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.499\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCoagulation function,blood clotting function\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eD- dimer(mg/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.69\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11.278\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDibrinogen(g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e4.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.389\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.697\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInflammatory factor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ehs-CRP(mg/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e8.91\u0026thinsp;\u0026plusmn;\u0026thinsp;6.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e7.96\u0026thinsp;\u0026plusmn;\u0026thinsp;5.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.804\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTNF-α(pg/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e38.53\u0026thinsp;\u0026plusmn;\u0026thinsp;18.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e37.22\u0026thinsp;\u0026plusmn;\u0026thinsp;16.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.861\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.389\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e3: Catheter-related factors and IVAP tip position[\u003cem\u003en\u003c/em\u003e(%)/༈\u003cspan class=\"InlineEquation\"\u003e\u003c/span\u003e༉]\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProject\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCRT(+)༈n\u0026thinsp;=\u0026thinsp;182༉\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCRT(-)༈n\u0026thinsp;=\u0026thinsp;418༉\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e/\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eRoute of catheterization\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVenae subclavia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e112(61.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e256(61.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.946\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJugular vein,vena jugularis interna\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70(38.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e162(38.76)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime of catheter insertion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e128.51\u0026thinsp;\u0026plusmn;\u0026thinsp;32.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108.75\u0026thinsp;\u0026plusmn;\u0026thinsp;28.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.528\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eCatheter Material\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolyurethane\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e105(57.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e234(55.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.697\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSilica gel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77(42.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e184(44.02)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eProphylactic Anticoagulation Use\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78(42.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119(28.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e11.903\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104(57.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e299(71.53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eTip Position of IVAP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSVC-RAJ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49(26.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e174(41.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e11.738\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot SVC-RAJ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e133(73.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e244(58.37)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Logistic Regression Analysis of Risk Factors for CRT in IVAP Patients\u003c/h2\u003e \u003cp\u003eUsing CRT diagnosis as the dependent variable, factors with P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in univariate analysis (age, BMI, NLR, ALB, catheterization duration, tip position, and prophylactic anticoagulation status) were incorporated as independent variables into a logistic regression model. The results demonstrated that all aforementioned factors were independent risk factors for CRT development (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). These findings are presented in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e4\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eVariable assignment\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEncoded\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAssignment method\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eDependent variable\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConfirmed cases of CRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCRT(+)= 1, CRT༈-༉= 0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eArgument\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eX1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReplace with the original value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eX2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReplace with the original value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor_staging\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eX3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅠ-Ⅱ= 0, Ⅲ-Ⅳ= 1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eX4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReplace with the original value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD-dimer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eX5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReplace with the original value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime of catheter insertion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eX6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReplace with the original value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreventive anticoagulation status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eX7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u0026thinsp;=\u0026thinsp;1, No\u0026thinsp;=\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTop position\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eX8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSVC-RAJ\u0026thinsp;=\u0026thinsp;1, Not SVC-RAJ\u0026thinsp;=\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogistic regression analysis of risk factors for CRT risk in IVAP patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInfluence Factor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWaldχ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eOR\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e95%\u003cem\u003eCI\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLower limit\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eUpper limit\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.754\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.077\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19.401\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.280\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor_staging\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.727\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.749\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3.195\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.398\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.076\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.489\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.730\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD-dimer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31.172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.280\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.569\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e7.131\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime of catheter insertion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37.663\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.039\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreventive anticoagulation status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.634\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.745\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.884\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.312\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2.707\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTop position\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.660\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.547\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.517\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.353\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.756\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eNote: β regression coefficient, SE standard error, OR odds ratio, 95%CI confidence interval.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.4 ROC Curve Analysis of the Prediction Model\u003c/h2\u003e \u003cp\u003eBased on the regression coefficients, a prediction model was constructed: Logit (P) = β₁X₁ + β₂X₂ + β₃X₃ + ... (where P represents probability, X represents relevant influencing factors, and β represents the regression coefficient of the corresponding independent variable). The regression coefficients and odds ratios (ORs) for each variable were calculated.\u003c/p\u003e \u003cp\u003eThe resulting regression equation for the combined prediction model was: Age0.049\u0026thinsp;+\u0026thinsp;BMI0.171\u0026thinsp;+\u0026thinsp;Tumor stage0.727\u0026thinsp;+\u0026thinsp;NLR0.398\u0026thinsp;+\u0026thinsp;D-dimer1.454\u0026thinsp;+\u0026thinsp;Catheterization duration0.029\u0026thinsp;+\u0026thinsp;Prophylactic anticoagulation use0.634\u0026thinsp;+\u0026thinsp;IVAP tip position-0.660.\u003c/p\u003e \u003cp\u003eThe prediction model was evaluated using receiver operating characteristic (ROC) curves, with calculation of the area under the curve (AUC) and 95% confidence intervals (CI). Results indicated that the combined prediction model demonstrated higher AUC values than any single parameter assessment. Detailed results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e5\u003c/span\u003e and Fig.\u0026nbsp;4.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eROC prediction value curve analysis of single and combined predictions of CRT risk in IVAP patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInfluence Factor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c3\" namest=\"c2\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eAUC\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eYI\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003e95%\u003cem\u003eCI\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSensitivity (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSpecificity (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLower limit\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eUpper limit\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.613\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.564\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.661\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e51.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e66.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.661\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.255\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.612\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.711\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e37.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e87.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor_staging\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.565\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.530\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.601\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e82.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e30.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.692\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.649\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.735\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e73.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e54.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD-dimer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.663\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.327\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.623\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.704\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e71.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e61.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime of catheter insertion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.715\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.339\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.669\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.761\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e67.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e66.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreventive anticoagulation status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.572\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.530\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.614\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e42.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e71.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTop position\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.574\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.533\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.614\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e73.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e41.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJoint projections\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.866\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.562\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.837\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.895\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e70.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e85.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e "},{"header":"4. Discussion","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Preventive Effect and Mechanism of SVC-RAJ Positioning on CRT\u003c/h2\u003e \u003cp\u003eThis study confirms that real-time ultrasound-guided positioning of IVAP tips in the SVC-RAJ region significantly reduced CRT incidence to 22.42%, representing a 42.1% reduction compared to the 38.73% observed in the non-SVC-RAJ group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This finding aligns with previous small-sample studies demonstrating ultrasound-guided positioning accuracy exceeding 92%\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. From a hemodynamic perspective, the SVC-RAJ region experiences blood flow velocities of 10\u0026ndash;15 cm/s due to right atrial contractile flushing, significantly higher than the 5\u0026ndash;8 cm/s observed in the mid-SVC region. This high-velocity flow reduces the temporal window for fibrin sheath deposition on catheter surfaces\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. Additionally, this region maintains a relatively constant vessel diameter (18\u0026ndash;22 mm), minimizing catheter-vessel wall contact area and thereby reducing the risk of mechanical endothelial injury\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Notably, although the SVC-RAJ group demonstrated lower baseline indicators for age and BMI compared to the non-SVC-RAJ group, multivariate regression analysis confirmed that tip position remained an independent protective factor (OR\u0026thinsp;=\u0026thinsp;0.517, 95% CI: 0.353\u0026ndash;0.756), suggesting that positioning strategy's clinical value persists regardless of patient baseline characteristics.\u003c/p\u003e \u003cp\u003eCompared with traditional X-ray positioning, real-time ultrasound guidance offers superior three-dimensional dynamic monitoring capabilities. The intracardiac electrocardiogram (ICE) combined with Doppler flow signal confirmation technique employed in this study enables real-time verification of tip position during catheterization, avoiding measurement errors due to respiratory movement (average error approximately 3\u0026ndash;5 mm) common in X-ray positioning\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. Precise ultrasound-guided positioning also reduces the frequency of catheter readjustments\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. In our study, the mean catheterization duration in the SVC-RAJ group was 15.69 days shorter than in the non-SVC-RAJ group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), potentially further reducing thrombosis risk by minimizing repeated endothelial injury.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Clinical Significance of Independent Risk Factors for CRT\u003c/h2\u003e \u003cp\u003eMultivariate logistic regression analysis identified eight independent risk factors for CRT, including age, BMI, and tumor stage. D-dimer demonstrated the highest OR at 4.280 (95% CI: 2.569\u0026ndash;7.131), suggesting that coagulation activation represents the core driving factor in CRT development. This aligns with Virchow's triad (blood stasis, endothelial injury, and hypercoagulability) commonly observed in cancer patients\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. As a fibrin degradation product, elevated D-dimer levels reflect excessive activation of the coagulation-fibrinolysis system and serve as a sensitive biomarker for predicting CRT\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePatients with stage III-IV tumors exhibited 2.096 times higher CRT risk compared to those with stage I-II disease, potentially related to increased tissue factor (TF) secretion in advanced malignancies. TF activates the extrinsic coagulation pathway, forming procoagulant networks in the tumor microenvironment. Advanced-stage patients also typically experience more severe inflammatory responses\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. Elevated neutrophil-to-lymphocyte ratio reflects immune-coagulation axis dysregulation\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e, with each unit increase in NLR associated with a 48.9% increased CRT risk (OR\u0026thinsp;=\u0026thinsp;1.489).\u003c/p\u003e \u003cp\u003eNotably, prophylactic anticoagulation appeared as a risk factor (OR\u0026thinsp;=\u0026thinsp;1.884), contradicting clinical intuition. Deeper analysis suggests indication bias\u0026mdash;clinicians likely prescribed anticoagulants preferentially to high-risk patients (elevated D-dimer, advanced malignancy), resulting in an anticoagulation group inherently predisposed to CRT. This highlights the importance of risk model-based anticoagulation decisions rather than relying on single indicators\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Predictive Performance and Clinical Application of the Nomogram Model\u003c/h2\u003e \u003cp\u003eThe combined prediction model developed in this study achieved an AUC of 0.866 (95% CI: 0.837\u0026ndash;0.895), with sensitivity of 70.33%, specificity of 85.89%, and Youden index of 0.562, demonstrating excellent clinical utility. Unlike single-parameter assessments, this model integrates hemodynamic factors (tip position), systemic status (age, BMI), tumor burden (staging), coagulation function (D-dimer), and procedural factors (catheterization duration) to create a multidimensional risk assessment system. The Hosmer-Lemeshow test (P\u0026thinsp;=\u0026thinsp;0.843) indicates good agreement between predicted and observed values, with the calibration curve showing less than 5% deviation between predicted probabilities and actual risk.\u003c/p\u003e \u003cp\u003eThe nomogram's visualization advantage provides a quantitative tool for clinical decision-making. For example, a 60-year-old patient with BMI 25 kg/m\u0026sup2;, stage III lung cancer, NLR 3.5, D-dimer 0.7 mg/L, catheterization duration of 60 days, no prophylactic anticoagulation, and catheter tip positioned outside the SVC-RAJ region would score approximately 220 points, corresponding to a 78.6% CRT risk probability. This indicates the need for enhanced preventive measures (e.g., ultrasound-guided catheter repositioning, therapeutic anticoagulation). This individualized assessment approach avoids \"one-size-fits-all\" prevention strategies. In our cohort, using a model-predicted risk threshold of \u0026ge;\u0026thinsp;50% as indication for anticoagulation would optimize prophylactic anticoagulation usage from 31.17% to 45.3%, while maintaining CRT missed diagnosis rates below 12.7%.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eWe recommend routine implementation of real-time ultrasound-guided techniques for IVAP implantation in cancer patients, with SVC-RAJ positioning (1\u0026ndash;2 cm above the right atrium junction) as the standard approach. For elderly patients (\u0026gt;\u0026thinsp;65 years), those with high BMI (\u0026gt;\u0026thinsp;28 kg/m\u0026sup2;), advanced-stage malignancies (stages III-IV), NLR\u0026thinsp;\u0026gt;\u0026thinsp;3.0, or D-dimer\u0026thinsp;\u0026gt;\u0026thinsp;0.5 mg/L, pre-catheterization CRT risk assessment using the nomogram model is advisable. High-risk patients may benefit from prophylactic low-molecular-weight heparin (enoxaparin 40 mg daily) and shortened ultrasound follow-up intervals (biweekly).\u003c/p\u003e \u003cp\u003eFuture research should focus on: (1) conducting multicenter prospective studies to validate the model's predictive performance across different cancer types; (2) exploring correlations between ultrasound-guided dynamic flow parameters (peak velocity, turbulence index) and CRT to enhance mechanistic understanding; and (3) developing molecular marker panels incorporating liquid biopsy (circulating tumor cells, extracellular vesicles) to improve model prediction accuracy. This multimodal risk assessment system integrating imaging, clinical indicators, and molecular biology will establish new pathways for precise CRT prevention and control.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eThe study was approved by the Zhongshan People's Hospital 's Ethics Committee (approval number: 2022-035-K037). Informed consent was waived due to the retrospective design, and data utilization adhered to the privacy protection principles outlined in the Declaration of Helsinki.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis work was supported by Guangdong Medical Science and Technology Research Fund Project, A2022336; Zhongshan social welfare science and technology research project, 2022B1101.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization, QL and YC; methodology, YY; software, JW; validation, JW; formal analysis, JL and QL; investigation, JW and JL; resources, YY; data curation, YY; writing\u0026mdash;original draft preparation, QL; writing\u0026mdash;review and editing, YC; visualization, YY; supervision, JL; project administration, YC; funding acquisition, YC. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and analysed during the current study are not publicly available due to a further study of this area but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eZhang X, Geng C. Unsuccessful removal of a totally implantable venous access port caused by thrombosis in the left brachiocephalic vein: A case report. Medicine. 2019;98(13):14985.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTian L, Feng X, Luo Hetal. Evidence-based summary of preventive care for central venous access device-related thrombosis in hospitalized children. BMC Nurs. 2024;23(1):664.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrover SP, Hisada YM, Kasthuri RS et al. (2021). Cancer Therapy-Associated Thrombosis. Arteriosclerosis, thrombosis, and vascular biology, 41(4), 1291\u0026ndash;1305.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi S, Lu Z, Wu S, et al. The dynamic role of platelets in cancer progression and their therapeutic implications. Nat Rev Cancer. 2024;24(1):72\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTian L, Feng X, Luo H, et al. Evidence-based summary of preventive care for central venous access device-related thrombosis in hospitalized children. BMC Nurs. 2024;23(1):664.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeng XB, Peng L, Zhang Jetal. (2023). Dual ultrasound-guided totally implantable venous access ports via the right internal jugular vein in pediatric patients with cancer: a preliminary experience in a single institution. World J Pediatr Surg, 6(3), e000509.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGreca A, Iacobone E, Elisei D, et al. ECHOTIP: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in adult patients. J Vasc Access. 2023;24(4):535\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChapela SP, Descotte EJ, Reberendo MJ. Nasoenteric tube doppler guided insertion. A case report and review of literature. Eur J Clin Nutr. 2022;76(6):907\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMack V, Ni\u0026szlig;ler D, Kasikci D, et al. Magnetic Tracking and Electrocardiography-Guided Tip Confirmation System Versus Fluoroscopy for Placement of Peripherally Inserted Central Catheters: A Randomized, Noninferiority Comparison. Cardiovasc Interv Radiol. 2020;43(12):1891\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFarge D, Frere C, Connors JM, International Initiative on Thrombosis and Cancer (ITAC) advisory panel. 2022 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer, including patients with COVID-19. Lancet Oncol. 2022;23(7):e334\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarrier M, Blais N, Crowther M et al. (2021). Treatment Algorithm in Cancer-Associated Thrombosis: Updated Canadian Expert Consensus. Current oncology (Toronto, Ont.), 28(6), 5434\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrtel TL, Neumann I, Ageno Wetal. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv. 2020;4(19):4693\u0026ndash;738.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEscrig Sos J, G\u0026oacute;mez Quiles L, Maiocchi K. The 8th edition of the AJCC-TNM classification: New contributions to the staging of esophagogastric junction cancer. La 8.\u0026ordf; edici\u0026oacute;n de la clasificaci\u0026oacute;n AJCC-TNM: nuevas aportaciones a la estadificaci\u0026oacute;n del c\u0026aacute;ncer de la uni\u0026oacute;n esofagog\u0026aacute;strica. Cir Esp. 2019;97(8):432\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBedrikovetski S, Dudi-Venkata NN, Kroon HM, et al. A prospective study of diagnostic accuracy of multidisciplinary team and radiology reporting of preoperative colorectal cancer local staging. Asia-Pac J Clin Oncol. 2023;19(1):206\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang RH, Wen WX, Jiang ZP, et al. The clinical value of neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR) and systemic inflammation response index (SIRI) for predicting the occurrence and severity of pneumonia in patients with intracerebral hemorrhage. Front Immunol. 2023;14:1115031.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEspitia O, Tissot A, Miossec A, et al. Upper extremity venous thrombosis in hospitalized patients: A prospective epidemiological study. Thromb Res. 2024;233:174\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDing W, Qiu L, Li T et al. (2022). Ultrasound-guided totally implantable venous access ports placement via right brachiocephalic vein in pediatric population: A clinical debut. Pediatr Blood Cancer, 69(10), e29911.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCorley A, Royle RH, Marsh Netal. Incidence and risk factors for central venous access device failure in hospitalized adults: A multivariable analysis of 1892 catheters. J Hosp Med. 2024;19(10):905\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuo H, Jin C, Li X et al. (2023). Quantified versus willful handgrip exercises for the prevention of PICC-related thrombosis: A meta-analysis and systematic review. Medicine, 102(10), e32706.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBu X, Wu X. Analysis of the preventive effect of upper limb exercise combined with intelligent grip ball on venous thrombosis in patients with peripheral central venous catheters. Am J translational Res. 2024;16(11):6709\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShi J, Shen J, Xiang Z, et al. Dynamic Needle Tip Positioning versus Palpation and Ultrasound for Arteriovenous Puncture: A Meta-analysis. Ultrasound Med Biol. 2021;47(8):2233\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMunshey F, Parra DA, McDonnell C, et al. Ultrasound-guided techniques for peripheral intravenous placement in children with difficult venous access. Paediatr Anaesth. 2020;30(2):108\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eViale PH, Schwartz RN. Venous thromboembolism in patients with cancer. Part II. Current treatment strategies. Clin J Oncol Nurs. 2004;8(5):465\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaul P, Tiwari AR, Kaul P, et al. Revisiting the Anatomical Landmark-Guided Central Venous Access Device Insertion: A Retrospective Cohort Study. World J Surg. 2023;47(10):2562\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiao SC, Shao SC, Gao S, et al. Augmented reality visualization for ultrasound-guided interventions: a pilot randomized crossover trial to assess trainee performance and cognitive load. BMC Med Educ. 2024;24(1):1058.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFellhofer-Hofer J, Franz C, Vey JA, et al. Chemokines as Prognostic Factor in Colorectal Cancer Patients: A Systematic Review and Meta-Analysis. Int J Mol Sci. 2024;25(10):5374.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVageli DP, Doukas PG, Goupou Ketal. Hypoxia-inducible factor 1alpha and vascular endothelial growth factor in Glioblastoma Multiforme: a systematic review going beyond pathologic implications. Oncol Res. 2024;32(8):1239\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNaik A, Adeleye O, Koester S, et al. Cerebrospinal Fluid Biomarkers for Diagnosis and the Prognostication of Acute Ischemic Stroke: A Systematic Review. Int J Mol Sci. 2023;24(13):10902.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVeitch AM, Radaelli F, Alikhan R. Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update. Gut. 2021;70(9):1611\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbraham NS, Barkun AN, Sauer BG, et al. American College of Gastroenterology-Canadian Association of Gastroenterology Clinical Practice Guideline: Management of Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Periendoscopic Period. Am J Gastroenterol. 2022;117(4):542\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Implantable venous infusion port, Catheter-related thrombosis, Superior vena cava-right atrial junction, Real-time ultrasound guidance","lastPublishedDoi":"10.21203/rs.3.rs-8576757/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8576757/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aimed to investigate the value of positioning the tip of implantable venous infusion ports (IVAPs) at the superior vena cava-right atrial junction (SVC-RAJ) under real-time ultrasound guidance for preventing catheter-related thrombosis (CRT), and to construct a risk prediction model based on multivariate logistic regression to provide evidence for precise clinical prevention and control.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eClinical data of adult cancer patients who received IVAP treatment at Zhongshan People's Hospital from June 2022 to June 2023 were retrospectively analyzed. Patients were divided into SVC-RAJ group and non-SVC-RAJ group according to the IVAP tip position, and the incidence of CRT was compared between the two groups. Independent risk factors for CRT were identified through multivariate logistic regression analysis, and a nomogram model was constructed. The model's performance was evaluated using receiver operating characteristic (ROC) curve analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe overall incidence of CRT was 30.33% (182/600). The CRT incidence in the SVC-RAJ group was 22.42%, significantly lower than the 38.73% in the non-SVC-RAJ group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Univariate analysis showed that age, BMI, neutrophil-to-lymphocyte ratio (NLR), catheterization duration, tumor stage, D-dimer, prophylactic anticoagulation use, and tip position were associated with CRT occurrence (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Multivariate logistic regression analysis identified the following independent risk factors for CRT: age (OR\u0026thinsp;=\u0026thinsp;1.050, 95% CI: 1.024\u0026ndash;1.077, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), BMI (OR\u0026thinsp;=\u0026thinsp;1.187, 95% CI: 1.100\u0026ndash;1.280, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), tumor stage (OR\u0026thinsp;=\u0026thinsp;2.096, 95% CI: 1.340\u0026ndash;3.195, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), NLR (OR\u0026thinsp;=\u0026thinsp;1.489, 95% CI: 1.282\u0026ndash;1.730, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), D-dimer (OR\u0026thinsp;=\u0026thinsp;4.280, 95% CI: 2.569\u0026ndash;7.131, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), catheterization duration (OR\u0026thinsp;=\u0026thinsp;1.030, 95% CI: 1.020\u0026ndash;1.039, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), prophylactic anticoagulation status (OR\u0026thinsp;=\u0026thinsp;1.884, 95% CI: 1.312\u0026ndash;2.707, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and tip position (OR\u0026thinsp;=\u0026thinsp;0.517, 95% CI: 0.353\u0026ndash;0.756, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The area under the ROC curve (AUC) of the combined prediction model was 0.866 (95% CI: 0.837\u0026ndash;0.895), with a sensitivity of 70.33%, specificity of 85.89%, and Youden index of 0.562, demonstrating good predictive performance.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePositioning the IVAP tip at the SVC-RAJ under real-time ultrasound guidance can significantly reduce the risk of CRT. The nomogram model constructed based on multiple factors demonstrates good predictive performance and can provide quantitative reference for individualized clinical prevention strategies.\u003c/p\u003e","manuscriptTitle":"Construction of a Risk Model for the Prevention of Catheter-Related Thrombosis by Positioning the Tip of Implantable Venous Infusion Port at the Superior Vena Cava-Right Atrial Junction under Real-Time Ultrasound Guidance: A Single-Center Retrospective Study in Adult Cancer Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-09 12:32:28","doi":"10.21203/rs.3.rs-8576757/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f1c44821-c919-46d9-972c-ec2f9ab3087e","owner":[],"postedDate":"February 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-11T05:25:13+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-09 12:32:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8576757","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8576757","identity":"rs-8576757","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}