Division of Hematology/Oncology/Bone Marrow Transplant, Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, United States of America.
Data Coordinating Center for Pediatric Multicenter Studies, Institute for Clinical and Translational Science, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States of America.
Thromb Res. 2022 Dec;220:116-120. doi: 10.1016/j.thromres.2022.10.010. Epub 2022 Oct 21.
The incidence of pediatric hospital-acquired venous thromboembolism (HA-VTE) has increased over time. Congenital heart disease (CHD) as a co-morbidity has been demonstrated to significantly increase HA-VTE risk among hospitalized children.
To identify specific risks factors for the development of HA-VTE in hospitalized children with CHD.
This retrospective case-control study included hospitalized participants aged 0-21 years within the Children's Hospital Acquired Thrombosis (CHAT) Consortium Registry with a co-morbidity of CHD. Participants with HA-VTE and non-VTE controls with a past medical history of CHD were selected from the CHAT Registry and data regarding multiple clinical variables were extracted. These variables were then analyzed to assess their association with HA-VTE development.
Three hundred and thirty-three participants with a co-morbidity of CHD were identified, comprising 275 HA-VTE cases and 58 controls. Median age for HA-VTE cases was 0.4 (IQR = 0-2.6) years compared to 3.4 (IQR = 0.7-6.5) for controls. Male participants were predominant in both groups (57.5 % HA-VTE cases vs 51.7 % controls). Multivariable analysis identified prior recent hospitalization (OR = 4.12, 95%CI = 1.66-10.24), intensive care unit (ICU) admission (OR = 3.29, 95 % CI = 1.15-9.40), and CVC placement (OR = 9.14, 95 % CI = 3.38-24.72) as significant risk factors for HA-VTE in subjects with CHD.
ICU admission, CVC placement, and prior hospitalization were identified as statistically significant predictors associated with HA-VTE development in hospitalized children with history of CHD. Prospective studies are needed to validate these results and help develop strategies to mitigate HA-VTE development in these patients.
儿科医院获得性静脉血栓栓塞症（HA-VTE）的发病率随着时间的推移而增加。合并先天性心脏病（CHD）已被证明会显著增加住院儿童发生 HA-VTE 的风险。
确定合并先天性心脏病的住院儿童发生 HA-VTE 的特定危险因素。
这项回顾性病例对照研究纳入了儿童医院获得性血栓形成（CHAT）联盟注册中心住院的年龄在 0-21 岁之间且合并 CHD 的患者。从 CHAT 登记处选择合并 HA-VTE 和非 VTE 且既往有 CHD 病史的患者作为对照，提取与多种临床变量相关的数据。然后对这些变量进行分析，以评估它们与 HA-VTE 发生的相关性。
确定了 333 名合并 CHD 的患者，包括 275 例 HA-VTE 病例和 58 例对照。HA-VTE 病例的中位年龄为 0.4（IQR=0-2.6）岁，而对照组为 3.4（IQR=0.7-6.5）岁。两组均以男性为主（HA-VTE 病例占 57.5%，对照组占 51.7%）。多变量分析确定近期住院（OR=4.12，95%CI=1.66-10.24）、入住重症监护病房（ICU）（OR=3.29，95%CI=1.15-9.40）和中心静脉导管（CVC）置入（OR=9.14，95%CI=3.38-24.72）是 CHD 患者发生 HA-VTE 的显著危险因素。
ICU 入住、CVC 置入和既往住院被确定为与合并 CHD 的住院儿童发生 HA-VTE 相关的具有统计学意义的预测因素。需要前瞻性研究来验证这些结果，并帮助制定策略以降低这些患者发生 HA-VTE 的风险。
