糖尿病酮症酸中毒重症患儿医院获得性静脉血栓栓塞症：一项多中心回顾性队列研究
Hospital-acquired venous thromboembolism among critically ill children with diabetic ketoacidosis: a multicenter, retrospective cohort study.
作者信息
DeMayo Kristin M, Havlicek Elizabeth E, Betensky Marisol, Goldenberg Neil A, Sochet Anthony A
机构信息
Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.
Center for Pediatric Clinical/Translational Research Training, Education, Engagement and Mentorship, Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.
出版信息
Res Pract Thromb Haemost. 2024 Oct 3;8(7):102581. doi: 10.1016/j.rpth.2024.102581. eCollection 2024 Oct.
BACKGROUND
Critically ill children and young adults with diabetic ketoacidosis are thought to be in a prothrombotic state. However, the rate of hospital-acquired venous thromboembolism and associated risk factors in this population have not been identified.
OBJECTIVES
Children hospitalized for diabetic ketoacidosis (DKA) may be at increased risk of hospital-acquired venous thromboembolism (HA-VTE). We sought to estimate the incidence of HA-VTE and identify unique prothrombotic risk factors in this population.
METHODS
We performed a multicenter, retrospective cohort study using the Pediatric Health Information Systems registry including patients aged 0 to 21 years hospitalized for DKA from January 2017 to December 2023 within 48 participating centers. The primary outcome was the frequency of HA-VTE. Secondary outcomes were rates of cerebral edema, central venous catheterization (CVC), invasive mechanical ventilation (IMV), infection, and length of stay (LOS). An adjusted logistic regression was employed to identify potential HA-VTE risk factors.
RESULTS
Of the 27,613 patients studied, 93 (0.3%) developed a HA-VTE. Compared with those without HA-VTE, those with HA-VTE had a greater median LOS (10 [IQR, 5-21] vs 2 [IQR, 2-3] days) and rates of cerebral edema (25.8% vs 6.6%), CVC (23.7% vs 1.1%), infection (72% vs 23.5%), and IMV (39.8% vs 1.4%; all < .001). In an adjusted logistic model, factors independently associated with increased HA-VTE were CVC (adjusted odds ratio [aOR], 3.04; 95% CI, 1.49-6.19), infection (aOR, 4.61; 95% CI, 2.81-7.56), IMV (aOR, 9.24; 95% CI, 4.83-17.56), and increasing LOS (aOR, 1.05; 95% CI, 1.02-1.06; all < .01).
CONCLUSION
The frequency of HA-VTE among critically ill children and young adults hospitalized for DKA was 0.3%. After prospective validation, putative risk factors (ie, CVC, IMV, infection, and extended LOS) may be incorporated into the design of forthcoming pediatric thromboprophylaxis trials.
背景
患有糖尿病酮症酸中毒的危重症儿童和青年被认为处于血栓前状态。然而，该人群中医院获得性静脉血栓栓塞症的发生率及相关危险因素尚未明确。
目的
因糖尿病酮症酸中毒（DKA）住院的儿童可能发生医院获得性静脉血栓栓塞症（HA-VTE）的风险增加。我们试图估计HA-VTE的发生率，并确定该人群中独特的血栓前危险因素。
方法
我们使用儿科健康信息系统登记处进行了一项多中心回顾性队列研究，纳入了2017年1月至2023年12月期间在48个参与中心因DKA住院的0至21岁患者。主要结局是HA-VTE的发生频率。次要结局是脑水肿、中心静脉置管（CVC）、有创机械通气（IMV）、感染的发生率以及住院时间（LOS）。采用校正逻辑回归来确定潜在的HA-VTE危险因素。
结果
在研究的27613例患者中，93例（0.3%）发生了HA-VTE。与未发生HA-VTE的患者相比，发生HA-VTE的患者中位LOS更长（10天[四分位间距，5 - 21天] vs 2天[四分位间距，2 - 3天]），脑水肿发生率更高（25.8% vs 6.6%），CVC使用率更高（23.7% vs 1.1%），感染发生率更高（72% vs 23.5%），IMV使用率更高（39.8% vs 1.4%；所有P <.001）。在校正逻辑模型中，与HA-VTE增加独立相关的因素是CVC（校正比值比[aOR]，3.04；95%置信区间[CI]，1.49 - 6.19）、感染（aOR，4.61；95% CI，2.81 - 7.56）、IMV（aOR，9.24；95% CI，4.83 - 17.56）以及LOS延长（aOR，1.05；95% CI，1.02 - 1.06；所有P <.01）。
结论
因DKA住院的危重症儿童和青年中HA-VTE的发生率为0.3%。经过前瞻性验证后，假定的危险因素（即CVC、IMV、感染和延长的LOS）可纳入即将开展的儿科血栓预防试验的设计中。
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