Association between early post-insertion arterial oxygen tension and documented acute upper-body deep or central venous thrombosis in critically ill adults: A retrospective MIMIC-IV cohort study
4 affiliations
- 1Department of Pulmonary and Critical Care Medicine, Shenzhen Key Laboratory of Respiratory Diseases, Shenzhen Clinical Research Center for Respiratory Disease, Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital (The First Affiliated Hospital, Southern University of Science and Technology, The Second Clinical Medical College, Jinan University), Shenzhen, China
- 2Department of Hepatobiliary Surgery, Shenzhen People’s Hospital, Shenzhen, Guangdong, China
- 3Department of Cardiology, Shenzhen People’s Hospital, Shenzhen, Guangdong, China
- 4Department of Nursing, Shenzhen People’s Hospital, Shenzhen, Guangdong, China
Abstract
Abnormal oxygenation may influence thrombosis, but evidence in catheterized critically ill patients remains limited. We examined whether the first arterial partial pressure of oxygen (PaO2) measured within 24 hours after qualifying invasive venous catheter insertion was associated with documented acute upper-body deep or central venous thrombosis during hospitalization. This retrospective observational cohort study used the Medical Information Mart for Intensive Care IV database, version 2.2 (MIMIC-IV v2.2) (2008–2019). Adult intensive care unit admissions were included when a qualifying invasive venous catheter was present and an arterial PaO2 measurement was obtained after insertion, within 24 hours, and while the catheter remained in situ. PaO2 was analyzed continuously and categorically (≤80, 81–100, and >100 mmHg). Logistic regression models sequentially adjusted for patient characteristics, laboratory measurements, catheter characteristics, measurement timing, inspired oxygen concentration, respiratory support, and non-respiratory organ dysfunction. Multiple imputation addressed missing covariate data, and patient-clustered robust standard errors accounted for repeated admissions. The cohort included 11,277 hospital admissions from 10,789 patients; 195 admissions (1.73%) had the primary outcome. In the unadjusted model, higher PaO2 was associated with lower odds of the outcome (odds ratio [OR] per 10-mmHg increase, 0.970; 95% confidence interval [CI], 0.952–0.987), but this association attenuated after adjustment. In the fully adjusted model, PaO2 was not associated with the outcome (OR, 1.008; 95% CI, 0.989–1.027; P = 0.430). Most secondary analyses supported the primary result, although the 60-minute sensitivity analysis yielded adjustment-dependent estimates. In the complete cohort, a single early post-insertion PaO2 measurement was not independently associated with documented acute upper-body deep or central venous thrombosis. These findings do not support PaO2-based thrombosis risk stratification or modification of oxygen therapy for thrombosis prevention. Future studies should incorporate repeated oxygenation measurements and accurately timed, imaging-confirmed thrombotic outcomes.
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BibTeX
@article{cui2026association,
title = {{Association between early post-insertion arterial oxygen tension and documented acute upper-body deep or central venous thrombosis in critically ill adults: A retrospective MIMIC-IV cohort study}},
author = {Qing Cui and Anshuai Fang and Haiyan Zhang and Qingtong Meng and Sijia Zhou and Yueming Peng and Weixiang Luo},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0359719},
url = {https://doi.org/10.1371/journal.pone.0359719},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Association between early post-insertion arterial oxygen tension and documented acute upper-body deep or central venous thrombosis in critically ill adults: A retrospective MIMIC-IV cohort study
AU - Qing Cui
AU - Anshuai Fang
AU - Haiyan Zhang
AU - Qingtong Meng
AU - Sijia Zhou
AU - Yueming Peng
AU - Weixiang Luo
PY - 2026
DA - 2026/10/05
JO - PLOS One
DO - 10.1371/journal.pone.0359719
UR - https://doi.org/10.1371/journal.pone.0359719
AB - Abnormal oxygenation may influence thrombosis, but evidence in catheterized critically ill patients remains limited. We examined whether the first arterial partial pressure of oxygen (PaO2) measured within 24 hours after qualifying invasive venous catheter insertion was associated with documented acute upper-body deep or central venous thrombosis during hospitalization. This retrospective observational cohort study used the Medical Information Mart for Intensive Care IV database, version 2.2 (MIMIC-IV v2.2) (2008–2019). Adult intensive care unit admissions were included when a qualifying invasive venous catheter was present and an arterial PaO2 measurement was obtained after insertion, within 24 hours, and while the catheter remained in situ. PaO2 was analyzed continuously and categorically (≤80, 81–100, and >100 mmHg). Logistic regression models sequentially adjusted for patient characteristics, laboratory measurements, catheter characteristics, measurement timing, inspired oxygen concentration, respiratory support, and non-respiratory organ dysfunction. Multiple imputation addressed missing covariate data, and patient-clustered robust standard errors accounted for repeated admissions. The cohort included 11,277 hospital admissions from 10,789 patients; 195 admissions (1.73%) had the primary outcome. In the unadjusted model, higher PaO2 was associated with lower odds of the outcome (odds ratio [OR] per 10-mmHg increase, 0.970; 95% confidence interval [CI], 0.952–0.987), but this association attenuated after adjustment. In the fully adjusted model, PaO2 was not associated with the outcome (OR, 1.008; 95% CI, 0.989–1.027; P = 0.430). Most secondary analyses supported the primary result, although the 60-minute sensitivity analysis yielded adjustment-dependent estimates. In the complete cohort, a single early post-insertion PaO2 measurement was not independently associated with documented acute upper-body deep or central venous thrombosis. These findings do not support PaO2-based thrombosis risk stratification or modification of oxygen therapy for thrombosis prevention. Future studies should incorporate repeated oxygenation measurements and accurately timed, imaging-confirmed thrombotic outcomes.
SN - 1932-6203
ER -