Department of Neurology, 24016Henry Ford Hospital, Detroit, MI, USA.
Division of Critical Care, Department of Medicine, 65106Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Intensive Care Med. 2020 Nov;35(11):1226-1234. doi: 10.1177/0885066619841547. Epub 2019 May 7.
Venous thromboembolism (VTE) is a potentially life-threatening complication among critically ill patients. Neurocritical care patients are presumed to be at high risk for VTE; however, data regarding risk factors in this population are limited. We designed this study to evaluate the frequency, risk factors, and clinical impact of VTE in neurocritical care patients.
We obtained data from the electronic medical record of all adult patients admitted to neurological intensive care unit (NICU) at Henry Ford Hospital between January 2015 and March 2018. Venous thromboembolism was defined as deep vein thrombosis, pulmonary embolism, or both diagnosed by Doppler, chest computed tomography (CT) angiography or ventilation-perfusion scan >24 hours after admission. Patients with ICU length of stay <24 hours or who received therapeutic anticoagulants or were diagnosed with VTE within 24 hours of admission were excluded.
Among 2188 consecutive NICU patients, 63 (2.9%) developed VTE. Prophylactic anticoagulant use was similar in patients with and without VTE (95% vs 92%; = .482). Venous thromboembolism was associated with higher mortality (24% vs 13%, = .019), and longer ICU (12 [interquartile range, IQR 5-23] vs 3 [IQR 2-8] days, < .001) and hospital (22 [IQR 15-36] vs 8 [IQR 5-15] days, < .001) length of stay. In a multivariable analysis, potentially modifiable predictors of VTE included central venous catheterization (odds ratio [OR] 3.01; 95% confidence interval [CI], 1.69-5.38; < .001) and longer duration of immobilization (Braden activity score <3, OR 1.07 per day; 95% CI, 1.05-1.09; < .001). Nonmodifiable predictors included higher International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) scores (which accounts for age >60, prior VTE, cancer and thrombophilia; OR 1.66; 95% CI, 1.40-1.97; < .001) and body mass index (OR 1.05; 95% CI, 1.01-1.08; = .007).
Despite chemoprophylaxis, VTE still occurred in 2.9% of neurocritical care patients. Longer duration of immobilization and central venous catheterization are potentially modifiable risk factors for VTE in critically ill neurological patients.
静脉血栓栓塞症（VTE）是危重症患者潜在的致命并发症。神经重症监护患者被认为存在发生 VTE 的高风险；然而，关于该人群的风险因素的数据有限。我们设计本研究旨在评估神经重症监护患者中 VTE 的频率、风险因素和临床影响。
我们从 2015 年 1 月至 2018 年 3 月期间亨利福特医院神经重症监护病房（NICU）所有成年患者的电子病历中获取数据。VTE 定义为入院 24 小时后通过多普勒、胸部计算机断层扫描（CT）血管造影或通气-灌注扫描诊断的深静脉血栓形成、肺栓塞或两者均有。排除 ICU 住院时间<24 小时或接受治疗性抗凝治疗或入院 24 小时内诊断为 VTE 的患者。
在 2188 例连续 NICU 患者中，63 例（2.9%）发生 VTE。接受预防性抗凝治疗的患者与未发生 VTE 的患者相似（95%比 92%； =.482）。VTE 与更高的死亡率（24%比 13%， =.019）和更长的 ICU（12[四分位距，IQR 5-23]比 3[IQR 2-8]天， <.001）和医院（22[IQR 15-36]比 8[IQR 5-15]天， <.001）住院时间相关。在多变量分析中，VTE 的潜在可修正预测因素包括中心静脉置管（比值比[OR]3.01；95%置信区间[CI]1.69-5.38； <.001）和更长的固定时间（Braden 活动评分<3，OR 每天增加 1.07；95%CI，1.05-1.09； <.001）。不可修正的预测因素包括更高的国际医学预防静脉血栓栓塞症注册（IMPROVE）评分（该评分考虑年龄>60 岁、既往 VTE、癌症和血栓形成倾向；OR 1.66；95%CI，1.40-1.97； <.001）和体重指数（OR 1.05；95%CI，1.01-1.08； =.007）。
尽管进行了化学预防，神经重症监护患者中仍有 2.9%发生 VTE。更长的固定时间和中心静脉置管是危重症神经患者中 VTE 的潜在可修正风险因素。
