Hospital-acquired venous thromboembolism among critically ill children with diabetic ketoacidosis: a multicenter, retrospective cohort study

Kristin M. DeMayo; Elizabeth E. Havlicek; Marisol Betensky; Neil A. Goldenberg; Anthony A. Sochet

Research and Practice in Thrombosis and Haemostasis (Oct 2024)

Hospital-acquired venous thromboembolism among critically ill children with diabetic ketoacidosis: a multicenter, retrospective cohort study

Kristin M. DeMayo,
Elizabeth E. Havlicek,
Marisol Betensky,
Neil A. Goldenberg,
Anthony A. Sochet

Affiliations

Kristin M. DeMayo: Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Florida, USA; Correspondence Kristin M. DeMayo, Department of Pediatrics, University of South Florida Morsani College of Medicine, 2 Tampa General Circle 5th Floor (#5036), Tampa, FL 33606, USA.
Elizabeth E. Havlicek: Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
Marisol Betensky: 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; Departments of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Cancer and Blood Disorders Institute, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida, USA
Neil A. Goldenberg: 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; Departments of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Cancer and Blood Disorders Institute, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Anthony A. Sochet: 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; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

Journal volume & issue: Vol. 8, no. 7
p. 102581

Abstract

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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 P < .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 P < .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.

Published in Research and Practice in Thrombosis and Haemostasis

ISSN: 2475-0379 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the blood and blood-forming organs
Website: https://www.sciencedirect.com/journal/research-and-practice-in-thrombosis-and-haemostasis

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