糖尿病酮症酸中毒危重患儿在医院获得性静脉血栓栓塞症：一项多中心回顾性队列研究

IF 3.4 3区医学 Q2 HEMATOLOGY

Research and Practice in Thrombosis and Haemostasis Pub Date : 2024-10-01 DOI:10.1016/j.rpth.2024.102581

Kristin M. DeMayo , Elizabeth E. Havlicek , Marisol Betensky , Neil A. Goldenberg , Anthony A. Sochet

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引用次数: 0

摘要

背景患有糖尿病酮症酸中毒的重症儿童和年轻成人被认为处于血栓形成前状态。目标因糖尿病酮症酸中毒（DKA）住院的儿童发生医院获得性静脉血栓栓塞症（HA-VTE）的风险可能增加。我们试图估算 HA-VTE 的发生率，并确定这一人群中独特的血栓形成前风险因素。方法我们利用儿科健康信息系统登记册开展了一项多中心、回顾性队列研究，研究对象包括 2017 年 1 月至 2023 年 12 月期间在 48 个参与中心因 DKA 住院的 0 至 21 岁患者。主要结果是 HA-VTE 的发生频率。次要结果是脑水肿、中心静脉导管插入术（CVC）、有创机械通气（IMV）、感染和住院时间（LOS）的发生率。结果在接受研究的27613名患者中，93人（0.3%）发生了HA-VTE。与未发生 HA-VTE 的患者相比，发生 HA-VTE 的患者的中位住院日（10 [IQR, 5-21] 天 vs 2 [IQR, 2-3] 天）和脑水肿率（25.8% vs 6.6%）、CVC（23.7% vs 1.1%）、感染（72% vs 23.5%）和 IMV（39.8% vs 1.4%；所有 P 均为 0.001）更高。在调整后的逻辑模型中，与 HA-VTE 增加独立相关的因素有 CVC（调整后的几率比 [aOR]，3.04；95% CI，1.49-6.19）、感染（aOR，4.61；95% CI，2.81-7.56）、IMV（aOR，9.24; 95% CI, 4.83-17.56), and increasing LOS (aOR, 1.05; 95% CI, 1.02-1.06; all P < .01).经过前瞻性验证后，推测的风险因素（即CVC、IMV、感染和延长的LOS）可纳入即将开展的儿科血栓预防试验的设计中。

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Hospital-acquired venous thromboembolism among critically ill children with diabetic ketoacidosis: a multicenter, retrospective cohort study

Background

Critically ill children and young adults with diabetic ketoacidosis are thought to be in a prothrombotic state. However, the rate of hospital-acquired venous thromboembolism and associated risk factors in this population have not been identified.

Objectives

Children hospitalized for diabetic ketoacidosis (DKA) may be at increased risk of hospital-acquired venous thromboembolism (HA-VTE). We sought to estimate the incidence of HA-VTE and identify unique prothrombotic risk factors in this population.

Methods

We performed a multicenter, retrospective cohort study using the Pediatric Health Information Systems registry including patients aged 0 to 21 years hospitalized for DKA from January 2017 to December 2023 within 48 participating centers. The primary outcome was the frequency of HA-VTE. Secondary outcomes were rates of cerebral edema, central venous catheterization (CVC), invasive mechanical ventilation (IMV), infection, and length of stay (LOS). An adjusted logistic regression was employed to identify potential HA-VTE risk factors.

Results

Of the 27,613 patients studied, 93 (0.3%) developed a HA-VTE. Compared with those without HA-VTE, those with HA-VTE had a greater median LOS (10 [IQR, 5-21] vs 2 [IQR, 2-3] days) and rates of cerebral edema (25.8% vs 6.6%), CVC (23.7% vs 1.1%), infection (72% vs 23.5%), and IMV (39.8% vs 1.4%; all P < .001). In an adjusted logistic model, factors independently associated with increased HA-VTE were CVC (adjusted odds ratio [aOR], 3.04; 95% CI, 1.49-6.19), infection (aOR, 4.61; 95% CI, 2.81-7.56), IMV (aOR, 9.24; 95% CI, 4.83-17.56), and increasing LOS (aOR, 1.05; 95% CI, 1.02-1.06; all P < .01).

Conclusion

The frequency of HA-VTE among critically ill children and young adults hospitalized for DKA was 0.3%. After prospective validation, putative risk factors (ie, CVC, IMV, infection, and extended LOS) may be incorporated into the design of forthcoming pediatric thromboprophylaxis trials.

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