Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, PO Box 22490, Mail code 1425, Riyadh, 11426, Saudi Arabia.
Thromb Res. 2013;132(6):671-5. doi: 10.1016/j.thromres.2013.09.036. Epub 2013 Sep 29.
The relationship between kidney function and venous thromboembolism (VTE) in critically ill patients is not well studied. The main objective of this study was to evaluate this relationship in patients admitted to a medical-surgical intensive care unit (ICU).
This was a retrospective study of 798 patients admitted to a tertiary-care ICU and prospectively followed for the development of clinically suspected and radiologically diagnosed deep venous thrombosis or pulmonary embolism. Patients were divided based on admission creatinine and dialysis history into five groups: normal kidney function, RIFLE classes R, I and F (combined=acute kidney injury [AKI]) and endstage renal disease (ESRD). We compared VTE prophylaxis practices and VTE incidence in these groups and evaluated renal failure as a VTE risk factor using multivariate Cox regression analysis.
Of the 798 patients, 27.2% had AKI and 10.1% had ESRD. Unfractionated heparin use was similar in the five groups but enoxaparin use was less frequent in AKI (13.4%) and ESRD (3.8%) patients compared with patients with normal kidney function (39.0%). VTE occurred in 7.6% of patients with normal renal function, 7.8% AKI patients and 2.5% ESRD patients (p=0.22). The adjusted hazard ratios for VTE compared to patients with normal kidney function were 0.35 (95% confidence interval [CI], 0.08-1.47) for RIFLE class R, 1.19 (95% CI, 0.83-1.70) for RIFLE class I, 0.82 (95% CI, 0.59-1.14) for RIFLE class F and 0.71 (95% CI, 0.49-1.02, p=0.06) for ESRD.
Neither AKI nor ESRD was an independent risk factors for critically ill patients.
危重病患者的肾功能与静脉血栓栓塞（VTE）之间的关系尚未得到充分研究。本研究的主要目的是评估入住内科-外科重症监护病房（ICU）的患者中这种关系。
这是一项对入住三级保健 ICU 的 798 例患者进行的回顾性研究，前瞻性随访这些患者是否发生临床疑似和放射学诊断的深静脉血栓形成或肺栓塞。根据入院时的肌酐和透析史，将患者分为 5 组：正常肾功能、RIFLE 分级 R、I 和 F（合并=急性肾损伤[AKI]）和终末期肾病（ESRD）。我们比较了这些组中 VTE 预防措施的实施情况和 VTE 的发生率，并使用多变量 Cox 回归分析评估了肾功能衰竭作为 VTE 的危险因素。
在 798 例患者中，27.2%有 AKI，10.1%有 ESRD。5 组之间普通肝素的使用情况相似，但 AKI（13.4%）和 ESRD（3.8%）患者中使用依诺肝素的情况较肾功能正常（39.0%）患者少。肾功能正常、AKI 患者和 ESRD 患者中 VTE 的发生率分别为 7.6%、7.8%和 2.5%（p=0.22）。与肾功能正常患者相比，VTE 的调整风险比分别为 RIFLE 分级 R 患者 0.35（95%置信区间[CI]，0.08-1.47）、RIFLE 分级 I 患者 1.19（95% CI，0.83-1.70）、RIFLE 分级 F 患者 0.82（95% CI，0.59-1.14）和 ESRD 患者 0.71（95% CI，0.49-1.02，p=0.06）。
AKI 和 ESRD 均不是危重病患者的独立危险因素。
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