内科重症监护患者深静脉血栓形成的发生率和风险因素及其对预后的影响。

IF 1.5 Q3 CRITICAL CARE MEDICINE

Indian Journal of Critical Care Medicine Pub Date : 2024-06-01 DOI:10.5005/jp-journals-10071-24723

Adhiti Krishnamoorthy, Samuel G Hansdak, John V Peter, Kishore Pichamuthu, Sudha J Rajan, Thomas I Sudarsan, Sridhar Gibikote, Lakshmanan Jeyaseelan, Thambu D Sudarsanam

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引用次数: 0

摘要

研究目的本研究评估了内科重症监护室（MICU）住院患者在接受血栓预防治疗期间深静脉血栓形成（DVT）的发生率和风险因素，并评估其对预后的影响：方法： MICU连续收治的患者在入院时、第3天和第7天均接受了颈静脉、腋静脉、股静脉和腘静脉加压超声检查，以筛查深静脉血栓。所有患者均按方案接受药物和/或机械血栓预防治疗。主要结果是深静脉血栓的发生率（定义为在第3天或第7天发生）。次要结果是死亡和住院时间。使用双变量和多变量逻辑回归分析探讨了深静脉血栓的风险因素，并以风险比（RR）和95%置信区间（CI）表示：深静脉血栓发生率为 17.2% (95% CI 12.0, 22.3) (n = 35/203)；三分之二与导管相关（23/35）。发生和未发生深静脉血栓的患者死亡率没有差异（9/35 vs 40/168，P = 0.81）。深静脉血栓组的平均（标清）住院时间更长（20.1 (17) 天 vs 12.9 (8.5) 天，p = 0.007）。虽然在双变量分析中，第 3 天 INR（RR 2.1，95% CI 0.9-5.3）、年龄大于 40 岁（2.1，0.8-5.3）、使用血管加压药（1.0，0.4-2.9）和 SOFA 评分（0.9，0.85-1.1）与深静脉血栓形成的发生有关，但在多变量分析中，只有中心静脉导管（15.97，1.9-135.8）与深静脉血栓形成独立相关：结论：尽管采取了血栓预防措施，但仍有 17% 的重症监护病房患者发生深静脉血栓。结论：尽管采取了血栓预防措施，但仍有 17% 的重症监护病房患者发生深静脉血栓，中心静脉导管是主要的风险因素。在采取预防措施的情况下，深静脉血栓与死亡率升高无关：Krishnamoorthy A、Hansdak SG、Peter JV、Pichamuthu K、Rajan SJ、Sudarsan TI 等：《内科重症监护患者深静脉血栓的发生率和风险因素及其对预后的影响》。Indian J Crit Care Med 2024;28(6):607-613.

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Incidence and Risk Factors for Deep Venous Thrombosis and Its Impact on Outcome in Patients Admitted to Medical Critical Care.

Objectives: This study evaluated the incidence and risk factors for deep venous thrombosis (DVT) while on thromboprophylaxis, in patients admitted to the medical intensive care unit (MICU), and to assess its impact on outcomes.

Methods: Consecutive patients admitted to the MICU underwent compression ultrasound of the jugular, axillary, femoral, and popliteal veins at admission, day 3 and 7 to screen for DVT. All patients were on pharmacological and/or mechanical thromboprophylaxis as per protocol. The primary outcome was the incidence of DVT (defined as occurrence on day 3 or 7). Secondary outcomes were death and duration of hospitalization. Risk factors for DVT were explored using bivariate and multivariable logistic regression analysis and expressed as risk ratio (RR) with 95% confidence intervals (CIs).

Results: The incidence of DVT was 17.2% (95% CI 12.0, 22.3) (n = 35/203); two-thirds were catheter associated (23/35). There was no difference in mortality between those with and without incident DVT (9/35 vs 40/168, p = 0.81). The mean (SD) duration of hospitalization was longer in the DVT group (20.1 (17) vs 12.9 (8.5) days, p = 0.007). Although day 3 INR (RR 2.1, 95% CI 0.9-5.3), age >40 years (2.1, 0.8-5.3), vasopressor use (1.0, 0.4-2.9) and SOFA score (0.9, 0.85-1.1) were associated with the development of DVT on bivariate analysis, only central venous catheters (15.97, 1.9-135.8) was independently associated with DVT on multivariable analysis.

Conclusions: Despite thromboprophylaxis, 17% of ICU patients develop DVT. The central venous catheter is the main risk factor. DVT is not associated with increased mortality in the setting of prophylaxis.

How to cite this article: Krishnamoorthy A, Hansdak SG, Peter JV, Pichamuthu K, Rajan SJ, Sudarsan TI, et al. Incidence and Risk Factors for Deep Venous Thrombosis and Its Impact on Outcome in Patients Admitted to Medical Critical Care. Indian J Crit Care Med 2024;28(6):607-613.

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来源期刊

Indian Journal of Critical Care Medicine CRITICAL CARE MEDICINE-

CiteScore

3.50

自引率

10.00%

发文量

299

期刊介绍： Indian Journal of Critical Care Medicine (ISSN 0972-5229) is specialty periodical published under the auspices of Indian Society of Critical Care Medicine. Journal encourages research, education and dissemination of knowledge in the fields of critical and emergency medicine.