VTE Incidence and Risk Factors in Patients with Severe Sepsis and Septic Shock.
Chest. 2015 Jun 25;
Authors: Kaplan D, Casper TC, Elliott CG, Men S, Pendleton RC, Kraiss LW, Weyrich AS, Grissom CK, Zimmerman GA, Rondina MT
Abstract
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 ICU patients 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 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 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 PE, proximal DVT, and/or symptomatic distal DVT) and associated with an increased length of stay (18.2±9.9 vs. 13.4±11.5 days, p<0.05). 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: 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 septic patients to VTE. More effective VTE prevention strategies are necessary in septic patients.
PMID: 26111103 [PubMed - as supplied by publisher]