VTE Incidence and Risk Factors in Patients With Severe Sepsis and Septic Shock
VTE Incidence and Risk Factors in Patients With Severe Sepsis and Septic Shock
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DOI：
10.1378/chest.15-0287
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发表时间：
2015-11-01
期刊：
影响因子：
9.6
通讯作者：
Rondina, Matthew T.
中科院分区：
文献类型：
--
作者：
Kaplan, David;Casper, T. Charles;Rondina, Matthew T.
背景：关于严重脓毒症和脓毒性休克期间 VTE 发生率的前瞻性研究仍然缺乏，阻碍了脓毒症 VTE 预防策略的疗效评估。方法：我们前瞻性研究了 3 家医院 ICU 连续入组的 113 名严重脓毒症和脓毒性休克患者。所有患者均提供知情同意书。记录所有患者的 VTE 血栓预防情况。患者在出院 ICU 之前接受超声检查并随访 VTE。记录28天全因死亡率。与 VTE 相关的单变量分析变量（包括中心静脉导管 [CVC] 插入、年龄、住院时间和机械通气）被纳入多变量逻辑回归分析中，使用后向逐步消除法确定 VTE 预测因子。 结果：平均 APACHE（急性生理学和慢性健康评估）II 评分为 18.2 +/- 7.0，年龄为 50 +/- 18 岁。尽管所有患者均接受指南推荐的血栓预防治疗，但 VTE 的发生率为 37.2%（95% CI，28.3-46.8）。大多数 VTE 事件具有临床意义（定义为肺栓塞、近端 DVT 和/或有症状的远端 DVT），并且与住院时间延长相关（18.2 +/- 9.9 天 vs 13.4 +/- 11.5 天，P < .05）。急性 VTE 患者的死亡率较高，但未达到统计学意义。插入 CVC 和较长的机械通气持续时间是重要的 VTE 危险因素。 VTE 的发生率并没有因血栓预防类型的不同而不同。 结论：据我们所知，这是第一项确定严重脓毒症和脓毒性休克患者中 VTE 发生率较高的多中心前瞻性研究，尽管使用了普遍的、指南推荐的血栓预防措施。我们的研究结果表明，脓毒症的全身炎症环境可能使脓毒症患者容易发生静脉血栓栓塞。脓毒症患者需要更有效的 VTE 预防策略。
BACKGROUND: Prospective studies on the incidence of VTE during severe sepsis and septic shock remain absent, hindering efficacy assessments regarding VTE prevention strategies in sepsis.METHODS: We prospectively studied 113 consecutively enrolled patients in the ICU with severe sepsis and septic shock at three hospitals. All patients provided informed consent. VTE thromboprophylaxis was recorded for all patients. Patients underwent ultrasonography and were followed for VTE prior to ICU discharge. All-cause 28-day mortality was recorded. Variables from univariate analyses that were associated with VTE (including central venous catheter [CVC] insertion, age, length of stay, and mechanical ventilation) were included in a multivariable logistic regression analysis using backward stepwise elimination to determine VTE predictors.RESULTS: Mean APACHE (Acute Physiology and Chronic Health Evaluation) II score was 18.2 +/- 7.0, and age was 50 +/- 18 years. Despite all patients receiving guideline-recommended thromboprophylaxis, the incidence of VTE was 37.2% (95% CI, 28.3-46.8). Most VTE events were clinically significant (defined as pulmonary embolism, proximal DVT, and/or symptomatic distal DVT) and associated with an increased length of stay (18.2 +/- 9.9 days vs 13.4 +/- 11.5 days, P < .05). Mortality was higher in patients with acute VTE but did not reach statistical significance. Insertion of a CVC and longer mechanical ventilation duration were significant VTE risk factors. VTE incidence did not differ by thromboprophylaxis type.CONCLUSIONS: To our knowledge this is the first multicenter prospective study to identify a high incidence of VTE in patients with severe sepsis and septic shock, despite the use of universal, guideline-recommended thromboprophylaxis. Our findings suggest that the systemic inflammatory milieu of sepsis may uniquely predispose patients with sepsis to VTE. More effective VTE prevention strategies are necessary in patients with sepsis.