Key result
History of VTE (aOR 4.77) and central venous catheters (aOR 2.93) were among the strongest prognostic factors associated with increased odds of venous thromboembolism in critically ill patients.
Why the study?
Prognostic factors for the development of venous thromboembolism in the ICU needed to be identified.
What patient-specific and ICU-related prognostic factors are associated with the development of venous thromboembolism in critically ill patients?
Meta-Analysis (n=729,477)
What patient-specific and ICU-related prognostic factors are associated with the development of venous thromboembolism in critically ill patients?
Patient-specific factors (e.g., history of VTE, active malignancy) and ICU-related factors (e.g., central venous catheter, lack of prophylaxis) are significantly associated with increased risk of VTE in critically ill patients, providing a foundation for risk stratification.
OBJECTIVE: To identify prognostic factors for the development of venous thromboembolism in the ICU. DATA SOURCES: We searched MEDLINE, EMBASE, and Cochrane CENTRAL from inception to March 1, 2021. STUDY SELECTION: We included English-language studies describing prognostic factors associated with the development of venous thromboembolism among critically ill patients. DATA EXTRACTION: Two authors performed data extraction and risk-of-bias assessment. We pooled adjusted odds ratios and adjusted hazard ratios for prognostic factors using random-effects model. We assessed risk of bias using the Quality in Prognosis Studies tool and certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations approach. DATA SYNTHESIS: We included 39 observational cohort studies involving 729,477 patients. Patient factors with high or moderate certainty of association with increased odds of venous thromboembolism include older age (adjusted odds ratio, 1.15; 95% CI, 1.02-1.29 per 10 yr), obesity (adjusted odds ratio, 1.25; 95% CI, 1.18-1.32), active malignancy (adjusted odds ratio, 1.70; 95% CI, 1.18-2.44), history of venous thromboembolism (adjusted odds ratio, 4.77; 95% CI, 3.42-6.65), and history of recent surgery (adjusted odds ratio, 1.77; 95% CI, 1.26-2.47). ICU-specific factors with high or moderate certainty of association with increased risk of venous thromboembolism include sepsis (adjusted odds ratio, 1.41; 95% CI, 1.12-1.78), lack of pharmacologic venous thromboembolism prophylaxis (adjusted odds ratio, 1.80; 95% CI, 1.14-2.84), central venous catheter (adjusted odds ratio, 2.93; 95% CI, 1.98-4.34), invasive mechanical ventilation (adjusted odds ratio, 1.74; 95% CI, 1.36-2.24), and use of vasoactive medication (adjusted odds ratio, 1.86; 95% CI, 1.23-2.81). CONCLUSIONS: This meta-analysis provides quantitative summaries of the association between patient-specific and ICU-related prognostic factors and the risk of venous thromboembolism in the ICU. These findings provide the foundation for the development of a venous thromboembolism risk stratification tool for critically ill patients.
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A 2021 study conducted a meta-analysis in Critically ill patients (n=729,477). History of venous thromboembolism vs. No history of venous thromboembolism was evaluated on Development of venous thromboembolism (aOR 4.77, 95% CI 3.42-6.65). History of VTE (aOR 4.77) and central venous catheters (aOR 2.93) were among the strongest prognostic factors associated with increased odds of venous thromboembolism in critically ill patients.
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