Woods Gary M, Boulet Sheree L, Texter Karen, Yates Andrew R, Kerlin Bryce A
Division of Hematology/Oncology/BMT Children's Healthcare of Atlanta Atlanta Georgia.
Department of Pediatrics Emory University School of Medicine Atlanta Georgia.
Res Pract Thromb Haemost. 2019 May 17;3(3):372-382. doi: 10.1002/rth2.12205. eCollection 2019 Jul.
Venous thromboembolism (VTE) is a complication in children with chronic pediatric heart disease (CPHD). The influence of acute VTE risk factors and the health care burden associated with VTE in CPHD is unknown. Children <18 years of age with a CPHD diagnostic code were identified from the 2003-2013 MarketScan Commercial Databases. VTE diagnoses were identified either concomitantly with initial CPHD diagnoses or during a 6-month follow-up. The associations between demographic and clinical characteristics and VTE among children with CPHD, stratified by recent cardiac surgery, were assessed by multivariable logistic regression models. Estimates of health care utilization were compared using Wilcoxon rank-sum tests. VTE events occurred in 957 of 120 884 children with CPHD (0.8%). In-hospital mortality was significantly higher in children with VTE. Single-ventricle physiology had the highest VTE rate (2.3%). All comorbid conditions were significantly associated with VTE, but the prevalence was highest in children with recent cardiac (11.1%) or noncardiac surgery (7.8%). The magnitude of association between noncardiac comorbidities and acquired acute cardiovascular conditions and VTE were larger for children without a recent cardiac surgery. Children with VTE had significantly higher health care utilization. VTE in CPHD is associated with significantly increased health care resource utilization and in-hospital mortality. All of the comorbid conditions examined were significantly associated with VTE, but a recent surgical procedure, especially cardiac surgery, conferred the highest VTE risk. Although confounding inherently limits observational studies, these findings provide practical information about the health care costs among patients with CPHD and VTE.
静脉血栓栓塞症（VTE）是慢性小儿心脏病（CPHD）患儿的一种并发症。急性VTE危险因素及CPHD中与VTE相关的医疗负担的影响尚不清楚。从2003 - 2013年市场扫描商业数据库中识别出诊断编码为CPHD的18岁以下儿童。VTE诊断要么与CPHD初始诊断同时确定，要么在6个月随访期间确定。通过多变量逻辑回归模型评估了按近期心脏手术分层的CPHD患儿的人口统计学和临床特征与VTE之间的关联。使用Wilcoxon秩和检验比较医疗保健利用率的估计值。120884例CPHD患儿中有957例发生VTE事件（0.8%）。VTE患儿的院内死亡率显著更高。单心室生理状态的VTE发生率最高（2.3%）。所有合并症均与VTE显著相关，但近期心脏手术（11.1%）或非心脏手术（7.8%）患儿的患病率最高。对于近期未进行心脏手术的患儿，非心脏合并症与获得性急性心血管疾病和VTE之间的关联程度更大。VTE患儿的医疗保健利用率显著更高。CPHD中的VTE与医疗保健资源利用率和院内死亡率显著增加相关。所有检查的合并症均与VTE显著相关，但近期手术，尤其是心脏手术，带来的VTE风险最高。尽管混杂因素固有地限制了观察性研究，但这些发现提供了有关CPHD和VTE患者医疗保健成本的实用信息。
