Division of Pediatric Hematology/Oncology, Children's Hospital of the King's Daughters, Norfolk, VA.
Division of Pediatric Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI.
J Pediatr. 2018 Jun;197:186-190.e1. doi: 10.1016/j.jpeds.2018.01.073. Epub 2018 Mar 28.
To describe the cumulative incidence of venous thromboembolism (VTE) in children with sickle cell disease (SCD) followed at a single institution and report on the risk factors associated with VTE development.
Charts for all patients with SCD, aged 0-21 years, followed at Nationwide Children's Hospital over a 6-year period (January 1, 2009, to January 31, 2015) were reviewed. Data on VTE diagnosis, sex, body mass index/weight-for-length, SCD genotype, SCD clinical complications, central venous catheter (CVC) placement, and thrombophilia testing were collected.
Cumulative incidence of VTE in children with SCD followed at a single tertiary care institution was found to be 2.9% (12/414). Nine of the 12 VTE were CVC-associated. On univariate analysis, hemoglobin SS genotype (OR 10.7, 95% CI 1.4-83.5), CVC presence (OR 34.4, 95% CI 8.9-134.6), central nervous system vasculopathy (OR 19.4, 95% CI 5.6-63.4), chronic transfusion therapy (OR 30.6, 95% CI 8.9-122.2), and older age (P = .03) were associated with VTE. However, presence of CVC was the only independent risk factor identified on multivariable logistic regression analysis (OR 33.8, 95% CI 8.7-130.9).
In our institution, nearly 3% of children with SCD had a history of VTE. CVC is an independent predictor of VTE in children with SCD.
描述在单一机构接受治疗的镰状细胞病（SCD）患儿静脉血栓栓塞症（VTE）的累积发病率，并报告与 VTE 发展相关的危险因素。
回顾了在 Nationwide Children's Hospital 接受治疗的 6 年间（2009 年 1 月 1 日至 2015 年 1 月 31 日）所有 0-21 岁 SCD 患儿的图表。收集了 VTE 诊断、性别、体重指数/体重与身高比、SCD 基因型、SCD 临床并发症、中心静脉导管（CVC）置管和血栓形成倾向检测的数据。
在一家三级保健机构接受治疗的 SCD 患儿的 VTE 累积发病率为 2.9%（12/414）。12 例 VTE 中有 9 例与 CVC 相关。单因素分析显示，血红蛋白 SS 基因型（OR 10.7，95%CI 1.4-83.5）、CVC 存在（OR 34.4，95%CI 8.9-134.6）、中枢神经系统血管病变（OR 19.4，95%CI 5.6-63.4）、慢性输血治疗（OR 30.6，95%CI 8.9-122.2）和年龄较大（P=0.03）与 VTE 相关。然而，CVC 的存在是多变量逻辑回归分析确定的唯一独立危险因素（OR 33.8，95%CI 8.7-130.9）。
在我们的机构中，近 3%的 SCD 患儿有 VTE 病史。CVC 是 SCD 患儿 VTE 的独立预测因素。
