医学重症监护病房患者深静脉血栓形成的发病率、危险因素及其对预后的影响
Incidence and Risk Factors for Deep Venous Thrombosis and Its Impact on Outcome in Patients Admitted to Medical Critical Care.
作者信息
Krishnamoorthy Adhiti, Hansdak Samuel G, Peter John V, Pichamuthu Kishore, Rajan Sudha J, Sudarsan Thomas I, Gibikote Sridhar, Jeyaseelan Lakshmanan, Sudarsanam Thambu D
机构信息
Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
Department of Critical Care, Christian Medical College, Vellore, Tamil Nadu, India.
出版信息
Indian J Crit Care Med. 2024 Jun;28(6):607-613. doi: 10.5005/jp-journals-10071-24723.
OBJECTIVES
This study evaluated the incidence and risk factors for deep venous thrombosis (DVT) while on thromboprophylaxis, in patients admitted to the medical intensive care unit (MICU), and to assess its impact on outcomes.
METHODS
Consecutive patients admitted to the MICU underwent compression ultrasound of the jugular, axillary, femoral, and popliteal veins at admission, day 3 and 7 to screen for DVT. All patients were on pharmacological and/or mechanical thromboprophylaxis as per protocol. The primary outcome was the incidence of DVT (defined as occurrence on day 3 or 7). Secondary outcomes were death and duration of hospitalization. Risk factors for DVT were explored using bivariate and multivariable logistic regression analysis and expressed as risk ratio (RR) with 95% confidence intervals (CIs).
RESULTS
The incidence of DVT was 17.2% (95% CI 12.0, 22.3) ( = 35/203); two-thirds were catheter associated (23/35). There was no difference in mortality between those with and without incident DVT (9/35 vs 40/168, = 0.81). The mean (SD) duration of hospitalization was longer in the DVT group (20.1 (17) vs 12.9 (8.5) days, = 0.007). Although day 3 INR (RR 2.1, 95% CI 0.9-5.3), age >40 years (2.1, 0.8-5.3), vasopressor use (1.0, 0.4-2.9) and SOFA score (0.9, 0.85-1.1) were associated with the development of DVT on bivariate analysis, only central venous catheters (15.97, 1.9-135.8) was independently associated with DVT on multivariable analysis.
CONCLUSIONS
Despite thromboprophylaxis, 17% of ICU patients develop DVT. The central venous catheter is the main risk factor. DVT is not associated with increased mortality in the setting of prophylaxis.
HOW TO CITE THIS ARTICLE
Krishnamoorthy A, Hansdak SG, Peter JV, Pichamuthu K, Rajan SJ, Sudarsan TI, . Incidence and Risk Factors for Deep Venous Thrombosis and Its Impact on Outcome in Patients Admitted to Medical Critical Care. Indian J Crit Care Med 2024;28(6):607-613.
目的
本研究评估了入住内科重症监护病房（MICU）的患者在接受血栓预防治疗期间深静脉血栓形成（DVT）的发生率和危险因素，并评估其对预后的影响。
方法
连续入住MICU的患者在入院时、第3天和第7天接受颈静脉、腋静脉、股静脉和腘静脉的加压超声检查，以筛查DVT。所有患者均按照方案接受药物和/或机械血栓预防治疗。主要结局是DVT的发生率（定义为在第3天或第7天发生）。次要结局是死亡和住院时间。使用二元和多变量逻辑回归分析探讨DVT的危险因素，并以风险比（RR）及95%置信区间（CI）表示。
结果
DVT的发生率为17.2%（95%CI 12.0，22.3）（n = 35/203）；三分之二与导管相关（23/35）。发生DVT的患者与未发生DVT的患者之间死亡率无差异（9/35对40/168，P = 0.81）。DVT组的平均（SD）住院时间更长（20.1（17）天对12.9（8.5）天，P = 0.007）。虽然在二元分析中，第3天的国际标准化比值（RR 2.1，95%CI 0.9 - 5.3）、年龄>40岁（2.1，0.8 - 5.3）、使用血管升压药（1.0，0.4 - 2.9）和序贯器官衰竭评估（SOFA）评分（0.9，0.85 - 1.1）与DVT的发生相关，但在多变量分析中，只有中心静脉导管（15.97，1.9 - 135.8）与DVT独立相关。
结论
尽管进行了血栓预防，仍有17%的ICU患者发生DVT。中心静脉导管是主要危险因素。在预防情况下，DVT与死亡率增加无关。
如何引用本文
Krishnamoorthy A，Hansdak SG，Peter JV，Pichamuthu K，Rajan SJ，Sudarsan TI等。内科重症监护病房患者深静脉血栓形成的发生率、危险因素及其对预后的影响。《印度重症监护医学杂志》2024；28（6）：607 - 613。
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