The Impact of Deep Vein Thrombosis on Outcomes in Critically Ill Patients: A Systematic Review and Meta-Analysis

Abstract Background: The clinical consequences of Deep Vein Thrombosis (DVT) have the potential to be serious yet are frequently unrecognized in the Intensive Care Unit (ICU). We hypothesized that both undetected and clinically evident VTE would affect the prognosis of critically ill patients Purpose: To systematically review whether a diagnosis of DVT in critically ill patients affects clinically important outcomes including length of stay, duration of mechanical ventilation and mortality. Material and Methods: Data sources used were the MEDLINE, EMBASE and PUBMED databases. Studies selected evaluated one or more of the following outcomes: duration of patient stay in hospital and in ICU, hospital and ICU mortality, and duration of mechanical ventilation. Two investigators independently extracted and reviewed data from each study; including study and patient characteristics and outcomes. Statistical heterogeneity was evaluated using the I2 statistic; Cohen’s Kappa for inter-rater agreement was used to assess inter-rater reliability. Data was pooled using the Mantel-Haenszel method and a random effects model using Review Manager. Results: Five studies were included in the systematic review. Patients diagnosed with DVT compared to those without DVT had increased ICU and hospital stay (7.3 days (95% confidence interval [CI] 1.4 to 13.2; P= 0.02) and 16.5 days (95% CI 1.51 to 30.59; P= 0.03), respectively. Duration of mechanical ventilation was increased by 3.41 days (95 % CI −1.12 to 7.94; P=0.14). Patients diagnosed with DVT also had increased relative risk (RR) for ICU mortality of 9.19 (95% CI 1.07 to 78.65, P=0.04) and a trend towards increased hospital mortality (RR 14.32 [95% CI 0.59 to 347.96, P = 0.10]). Conclusions: A diagnosis of DVT upon ICU admission appears to affect clinically important outcomes including length of ICU and hospital stay and ICU mortality. Further research involving larger prospective study designs are warranted. Outcomes Study Duration of mechanical ventilation in days (DVT/NO DVT) Hospitalization length In days (DVT/NO DVT) ICU Stay In days (DVT/NO DVT) Hospital mortality rate (DVT/NO DVT) n (%) ICU mortality rate (DVT, n/NO DVT, n) Legend PEPP: positive end-expiratory pressur * IQR ** median “ [95%CI]) ^ Necessity for ventilation measured by PEEP ≥10: DVT/no DVT: 11 (42%)/37 (21%) Ibrahim  2002 18.9±19.7/14.6±12.9M  p=0.310 31.4±21.7/27.5± 18.2  p=0.375 18.6±14.6/15.9±1.04  p=0.388 8.9 (34.6%)/26.8(32.1)  p=0.815 n/a Velmahos  1998 Not given. ^ 49±32/31±24, p=< 0.05 34±31/19±18, p=<0.05 n/a 31%,8.06/18%,31.2 Major  2003 n/a n/a n/a n/a 17%, 2/2%, 15  p=0.03 Patel  2005 n/a 26**  (14,49)*/− 6**  (3,15)*/− 70**  (28.5%) [22.8–34.1])″/− 16.7%,41 [12.0- 21.3]″/− Cook  2005 9** (4,25)*/6 (3,13)*   p=0.03 51** (24,73)*/23 **  (12,47)*  p=<0.001 17.5** (8.5, 30.5)*/9** (5,17)* 17 (53.1%)/85  (37.4%)  p=0.04 -, 8 **/−, 62**  p=0.78

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Prevalence of Low Limb Venous Thromboembolic Events in Mild and Severe/Critically Ill Patients with COVID-19 Despite Pharmacological Thromboprophylaxis

Blood ◽

10.1182/blood-2020-142077 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 38-38

Author(s):

Cong Zhang ◽

Jialan Shi ◽

Changjun WU ◽

Chunxu Wang ◽

Xinyi Zhao ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Mortality Rate ◽

Critically Ill ◽

Critically Ill Patients ◽

Thromboembolic Events ◽

Vein Thrombosis ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic ◽

Deep Vein ◽

D Dimer

Background:The prevalence of deep vein thrombosis in hospitalized patients with COVID-19 is higher and is associated with adverse outcomes. However, the treatment options received by patients with different classifications are different, and previous studies have not discussed the differences in specific coagulation parameters between patients with mild, severe, and critically ill COVID-19. Aim:To investigate the change in coagulation function and the incidence of low limb venous thromboembolic events in mild/severe/critically ill patients with COVID-19. Methods:A retrospective analysis of coagulation parameters and lower extremity venous ultrasound examination results in 77 patients with laboratory-confirmed COVID-19 admitted to the first affiliated hospital of Harbin Medical University. We discussed the occurrence of vascular complications in patients with normal, severe and critically ill patients Rate and explore the nature of such vascular events. The anticoagulation dose was left to the discretion of the treating physician based on the individual risk of thrombosis and patients were classified as treated with prophylactic anticoagulation or therapeutic anticoagulation. Approval was obtained from the local institutional review board and all procedures were performed in accordance with the Declaration of Helsinki. Results:The incidence of low limb venous thromboembolic events in COVID-19 patients included in the study was 28.6% (22/77). A total of 22 cases with deep vein thrombosis, 13 of whom with multiple thrombosis events, and 9 cases with independent distal deep vein thrombosis. There were 0 cases, 8 cases (17.4%) and 14 cases (87.5%) of patients with deep vein thrombosis occurred in mild, severe and critically ill patients, respectively. There were 4 cases (50%) and 9 cases (64.29%) of severe and critically ill patients with multiple deep vein thrombosis events, respectively. There was no difference in age and gender between patients with lower extremity venous thrombosis and those without. The mortality rate of patients with thrombotic events has an upward trend; the mortality rate of patients with thrombosis is 18.18%, and the mortality rate of patients without thrombosis is 3.64%. Compared with mild patients, white blood cell counts, neutrophil percentage, fibrinogen, IL-6, IL-10 serum levels are higher in severe and critically ill patients. The patients whose ultrasonography reported thrombosis mostly showed a dynamic increase and/or a significant increase in D-dimer. The patients whose ultrasonography reported no thrombosis showed mildly elevated D-dimer or within the normal range. Conclusions:The development of massive venous thrombotic events, as observed in our study cohort, suggests the possibility of COVID-19 associated hypercoagulability and endothelial activation and/or dysfunction in affected individuals. Figure Disclosures No relevant conflicts of interest to declare.

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