Diabetic Ketoacidosis and Venous Thromboembolism: A North American Virtual Pediatric Systems Registry Study, 2014-2023.

Abstract

Objectives: To estimate the occurrence rate of venous thromboembolism (VTE) among critically ill children and young adults with diabetic ketoacidosis (DKA) and evaluate putative prothrombotic risk factors using a multicenter data registry.

Design: Multicenter, observational, retrospective study utilizing a cohort derived from the Virtual Pediatric Systems database from October 1, 2014, to December 31, 2023.

Setting: One hundred thirty-nine North American PICUs.

Patients: Critically ill children and young adults older than 30 days to younger than 21 years old with principal admission diagnosis of DKA, excluding neonates, postcardiac surgical patients, and children with length of stay (LOS) less than 1 day.

Interventions: None.

Measurements and main results: Of 21,549 encounters, 62 (0.29%) developed VTE (mean annual rate, 0.29% ± 0.06%) and 32 of 62 (55%) were hospital-acquired VTE. Patients with, as compared to without, VTE experienced greater rates of sepsis (43.6% vs. 0.7%), cerebral edema (17.7% vs. 3.1%), central venous catheterization (CVC: 66.1% vs. 3.8%), invasive mechanical ventilation (46.8% vs. 2.3%), and a greater LOS (median, 4.9 d [interquartile range (IQR), 2.6-12.2 d] vs. 1.4 d [IQR, 1.1-1.9 d]; all p < 0.001). Regarding DKA-specific prothrombotic risk factors, those with (as compared to without) VTE had more severe acidosis (median admission pH, 6.96 [IQR, 6.82-7.13] vs. 7.07 [IQR, 6.96-7.18]), hyperglycemia (median, 590 mg/dL [IQR, 453-834 mg/dL] vs. 406 mg/dL [IQR, 310-548 mg/dL]), and reduced Glasgow Coma Scale scores (median, 12 [IQR, 6-14] vs. 15 [IQR, 14-15]; all p < 0.001). In an adjusted model, the presence of a CVC (adjusted odds ratio, 23.27; 95% CI, 6.63-81.6; p < 0.001) and concurrent sepsis/infection (odds ratio, 6.69; 95% CI, 2.37-18.87; p < 0.001) were associated with VTE.

Conclusions: In this multicenter observational study of critically ill children and young adults hospitalized with DKA, the estimated occurrence rate of VTE was 0.29% and, in an adjusted model, associated with CVC and concurrent infection/sepsis.