Department of Neurology, Henry Ford Hospital, Detroit, MI.
Division of Critical Care, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Crit Care Med. 2020 Jun;48(6):e470-e479. doi: 10.1097/CCM.0000000000004306.
To identify risk factors and develop a prediction score for in-hospital symptomatic venous thromboembolism in critically ill patients.
Retrospective cohort study.
Henry Ford Health System, a five-hospital system including 18 ICUs.
We obtained data from the electronic medical record of all adult patients admitted to any ICU (total 264 beds) between January 2015 and March 2018.
None.
Symptomatic venous thromboembolism was defined as deep vein thrombosis, pulmonary embolism, or both, diagnosed greater than 24 hours after ICU admission and confirmed by ultrasound, CT, or nuclear medicine imaging. A prediction score (the ICU-Venous Thromboembolism score) was derived from independent risk factors identified using multivariable logistic regression. Of 37,050 patients who met the eligibility criteria, 529 patients (1.4%) developed symptomatic venous thromboembolism. The ICU-Venous Thromboembolism score consists of six independent predictors: central venous catheterization (5 points), immobilization greater than or equal to 4 days (4 points), prior history of venous thromboembolism (4 points), mechanical ventilation (2 points), lowest hemoglobin during hospitalization greater than or equal to 9 g/dL (2 points), and platelet count at admission greater than 250,000/μL (1 point). Patients with a score of 0-8 (76% of the sample) had a low (0.3%) risk of venous thromboembolism; those with a score of 9-14 (22%) had an intermediate (3.6%) risk of venous thromboembolism (hazard ratio, 6.7; 95% CI, 5.3-8.4); and those with a score of 15-18 (2%) had a high (17.7%) risk of venous thromboembolism (hazard ratio, 28.1; 95% CI, 21.7-36.5). The overall C-statistic of the model was 0.87 (95% CI, 0.85-0.88).
Clinically diagnosed symptomatic venous thromboembolism occurred in 1.4% of this large population of ICU patients with high adherence to chemoprophylaxis. Central venous catheterization and immobilization are potentially modifiable risk factors for venous thromboembolism. The ICU-Venous Thromboembolism score can identify patients at increased risk for venous thromboembolism.
确定危重症患者院内有症状静脉血栓栓塞的风险因素，并制定预测评分。
回顾性队列研究。
亨利福特健康系统，一个包括 18 个 ICU 的五家医院系统。
我们从 2015 年 1 月至 2018 年 3 月期间所有入住任何 ICU（共 264 张床位）的成年患者的电子病历中获取数据。
无。
有症状静脉血栓栓塞定义为 ICU 入院后大于 24 小时诊断的深静脉血栓形成、肺栓塞或两者均有，并通过超声、CT 或核医学成像证实。使用多变量逻辑回归确定独立风险因素后得出预测评分（ICU-静脉血栓栓塞评分）。在符合入选标准的 37050 名患者中，有 529 名（1.4%）患者发生有症状静脉血栓栓塞。ICU-静脉血栓栓塞评分由六个独立预测因素组成：中心静脉置管（5 分）、固定大于或等于 4 天（4 分）、静脉血栓栓塞史（4 分）、机械通气（2 分）、住院期间最低血红蛋白大于或等于 9 g/dL（2 分）和入院时血小板计数大于 250,000/μL（1 分）。得分 0-8 分的患者（样本的 76%）静脉血栓栓塞风险低（0.3%）；得分 9-14 分的患者（22%）静脉血栓栓塞风险中等（3.6%）（危险比，6.7；95%CI，5.3-8.4）；得分 15-18 分的患者（2%）静脉血栓栓塞风险高（17.7%）（危险比，28.1；95%CI，21.7-36.5）。该模型的总体 C 统计量为 0.87（95%CI，0.85-0.88）。
在高遵医嘱进行化学预防的情况下，该大型 ICU 患者人群中，临床诊断的有症状静脉血栓栓塞发生率为 1.4%。中心静脉置管和固定是静脉血栓栓塞的潜在可改变风险因素。ICU-静脉血栓栓塞评分可识别静脉血栓栓塞风险增加的患者。
