Chest
Original ResearchCritical CareVTE Incidence and Risk Factors in Patients With Severe Sepsis and Septic Shock
Section snippets
Results
We prospectively enrolled 113 consecutively identified patients in the ICU with severe sepsis or septic shock (Fig 1, Table 1). Upon study entry, the mean APACHE II score was 18.2, > 50% of patients had shock requiring vasopressors, and > 75% required mechanical ventilation (Table 1). Overall, 61.1% of patients (69 of 113) had a CVC placed as part of their ICU care. More than 50% of patients had obesity, a known risk factor for VTE (Table 1). All-cause 28-day mortality was 21.2% (95% CI,
Discussion
To our knowledge, this is the first prospective, multicenter study to investigate VTE incidence, outcomes, and risk factors in patients admitted to the ICU with severe sepsis and septic shock. We identified a high incidence of VTE (37.2%) in patients with sepsis despite the use of universal, guideline-recommended thromboprophylaxis. The majority of patients (88%) had clinically significant VTE (symptomatic PE, proximal DVT, or symptomatic distal DVT) that influenced clinical management and was
Conclusions
In conclusion, patients with severe sepsis and septic shock have a high incidence of VTE, despite the use of universal, guideline-recommended thromboprophylaxis. More effective VTE prevention strategies are necessary in patients with sepsis, and future research in this population is urgently needed. Among these high-risk patients, removing CVCs when no longer necessary, minimizing the size of CVCs or avoiding their use when feasible, and strategies for early extubation may reduce the incidence
Acknowledgments
Author contributions: M. T. R. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis, including and especially any adverse effects. D. K. contributed to data analysis, critical writing, and intellectual content; T. C. C. contributed to statistical analysis and intellectual content; C. G. E., S. M., and R. C. P. contributed to critical writing and intellectual content; L. W. K., A. S. W., C. K. G., G. A. Z., and
References (23)
- et al.
Venous thromboembolic disease: an observational study in medical-surgical intensive care unit patients
J Crit Care
(2000) - et al.
Low-molecular-weight heparin thromboprophylaxis in medical-surgical critically ill patients: a systematic review
J Crit Care
(2009) - et al.
The incidence of deep venous thrombosis in ICU patients
Chest
(1997) - et al.
Prevention of venous thromboembolism in critically ill medical patients: a Franco-Canadian cross-sectional study
J Crit Care
(2003) - et al.
Prevention of VTE in nonsurgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines
Chest
(2012) - et al.
Venous thromboembolism in critical illness in a community intensive care unit
J Crit Care
(2007) - et al.
In vivo platelet activation in critically ill patients with primary 2009 influenza A(H1N1)
Chest
(2012) - et al.
The septic milieu triggers expression of spliced tissue factor mRNA in human platelets
J Thromb Haemost
(2011) - et al.
Risk of symptomatic DVT associated with peripherally inserted central catheters
Chest
(2010) - et al.
Deep vein thrombosis and its prevention in critically ill adults
Arch Intern Med
(2001)
Prevalence of deep venous thrombosis among patients in medical intensive care
JAMA
Cited by (193)
Society for Maternal-Fetal Medicine Consult Series #67: Maternal sepsis
2023, American Journal of Obstetrics and GynecologyAn Evolving Understanding of the Basis and Management of Vascular Complications of COVID-19: Where Do We Go From Here?
2023, Canadian Journal of CardiologyThe mechanistic and structural role of von Willebrand factor in endotoxemia-enhanced deep vein thrombosis in mice
2023, Journal of Thrombosis and HaemostasisFactors influencing DVT formation in sepsis
2024, Thrombosis JournalHigh and intermediate risk pulmonary embolism in the ICU
2024, Intensive Care Medicine
originally published Online First June 25, 2015.
FUNDING/SUPPORT: This work was supported by the National Institutes of Health [Grants HL092161 to M. T. R. and HL112311 to A. S. W.) and the National Institute on Aging [Grants AG040631 and AG048022 to M. T. R.]. This work was also supported by the University of Utah Study Design and Biostatistics Center, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health [Grant 8UL1TR000105 (formerly UL1RR025764)].