Incidence, prognostic factors, and outcomes of venous thromboembolism in critically ill patients: data from two prospective cohort studies

Ruben J Eck, Lisa Hulshof, Renske Wiersema, Chris H L Thio, Bart Hiemstra, Niels C Gritters van den Oever, Reinold O B Gans, Iwan C C van der Horst, Karina Meijer, Frederik Keus, Ruben J Eck, Lisa Hulshof, Renske Wiersema, Chris H L Thio, Bart Hiemstra, Niels C Gritters van den Oever, Reinold O B Gans, Iwan C C van der Horst, Karina Meijer, Frederik Keus

Abstract

Background: The objective of this study was to describe the prevalence, incidence, prognostic factors, and outcomes of venous thromboembolism in critically ill patients receiving contemporary thrombosis prophylaxis.

Methods: We conducted a pooled analysis of two prospective cohort studies. The outcomes of interest were in-hospital pulmonary embolism or lower extremity deep vein thrombosis (PE-LDVT), in-hospital nonleg deep vein thrombosis (NLDVT), and 90-day mortality. Multivariable logistic regression analysis was used to evaluate the association between predefined baseline prognostic factors and PE-LDVT or NLDVT. Cox regression analysis was used to evaluate the association between PE-LDVT or NLDVT and 90-day mortality.

Results: A total of 2208 patients were included. The prevalence of any venous thromboembolism during 3 months before ICU admission was 3.6% (95% CI 2.8-4.4%). Out of 2166 patients, 47 (2.2%; 95% CI 1.6-2.9%) developed PE-LDVT and 38 patients (1.8%; 95% CI 1.2-2.4%) developed NLDVT. Renal replacement therapy (OR 3.5 95% CI 1.4-8.6), respiratory failure (OR 2.0; 95% CI 1.1-3.8), and previous VTE (OR 3.6; 95% CI 1.7-7.7) were associated with PE-LDVT. Central venous catheters (OR 5.4; 95% CI 1.7-17.8) and infection (OR 2.2; 95% CI 1.1-4.3) were associated with NLDVT. Occurrence of PE-LDVT but not NLDVT was associated with increased 90-day mortality (HR 2.7; 95% CI 1.6-4.6, respectively, 0.92; 95% CI 0.41-2.1).

Conclusion: Thrombotic events are common in critically ill patients, both before and after ICU admittance. Development of PE-LDVT but not NLDVT was associated with increased mortality. Prognostic factors for developing PE-LDVT or NLDVT despite prophylaxis can be identified at ICU admission and may be used to select patients at higher risk in future randomized clinical trials.

Trial registration: NCT03773939.

Keywords: Cohort studies; Critical care; Critical illness; Embolism; Venous thromboembolism.

Conflict of interest statement

KM reports grants from Bayer, Sanquin, and Pfizer; speaker fees from Bayer, Sanquin, Boehringer Ingelheim, BMS, and Aspen; travel support from Bayer, and consulting fees from Uniqure outside the submitted work; other authors have disclosed no potential conflicts of interest.

Figures

Fig. 1
Fig. 1
Prognostic factors for PE-LDVT and NLDVT: results from the main analysis. All analyses were adjusted for anticoagulant use in addition to the other variables. CI confidence interval, CVC central venous catheter, NLDVT nonleg deep vein thrombosis, OR odds ratio, PE-LDVT pulmonary embolism and lower extremity deep vein thrombosis, RRT renal replacement therapy, VTE venous thromboembolism
Fig. 2
Fig. 2
Prognostic factors for PE-LDVT and NLDVT: results from the main analysis and sensitivity analyses. All analyses were adjusted for anticoagulant use in addition to the other variables. Main: main analysis including CVC as a predictor, results, therefore, differ slightly from the text and Fig. 1; S1: sensitivity analysis 1, the complete case analysis; S2: sensitivity analysis 2, excluding patients with outcome events detected within the first two days of ICU admission. CI confidence interval, CVC central venous catheter, NLDVT nonleg deep vein thrombosis, OR odds ratio, PE-LDVT pulmonary embolism and lower extremity deep vein thrombosis, RRT renal replacement therapy, VTE venous thromboembolism

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Source: PubMed

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