PURPOSE: Coagulation abnormalities are common in septic shock. Disseminated intravascular coagulation is the most frequent characterized by both pro and anticoagulant state. This encompasses defects in the anticoagulation system and is thus a procoagulant state as well. The degree to which the pro-coagulant abnormalities are manifested remains uncertain. We aimed to examine the frequency and outcomes of venous thromboembolism (VTE) in patients with SS and the subset with septic shock and DIC.
METHODS: Using the Nationwide Inpatient Sample 2007, patients older than18 years, discharged with any diagnosis of septic shock (785.52) were identified through appropriate ICD-9-CM codes. The primary diagnosis of VTE along with any secondary diagnosis of VTE with procedure codes of thrombolysis, IVC filter placement and use of anticoagulants were used to identify primary VTE. Outcome variables included frequency, in-hospital mortality and length of stay. Multivariate logistic regression was used to adjust for age, sex, race and other risk factors for VTE.
RESULTS: There were total of 232,848(0.41%) adjusted adult discharges with septic shock in 2007. The frequency of VTE was 1.76% in septic shock when compared to overall frequency of 1.14% in patients who did not have septic shock (adjusted OR 1.22; 95%CI 1.14-1.31). In subgroup analysis, the frequency of VTE was 2.3% in patients with septic shock and DIC (OR 1.64; 95%CI 1.23-2.17).In-hospital mortality in patients admitted with septic shock was not significantly different when compared to septic shock with VTE (41.2% vs. 40.3%). The length of stay was 14.4 days higher in patients with septic shock admitted with VTE versus septic shock alone (95% CI 11.5-14.6 days).
CONCLUSION: Prospective studies are needed to evaluate the causation of higher frequency of VTE in septic shock and DIC.
CLINICAL IMPLICATIONS: This observational study shows higher frequency of VTE in patients with septic shock and even higher in those developing DIC. The in hospital mortality of septic shock was not significantly different in patients developing VTE but led to significant increase in length of stay.
DISCLOSURE: Amit Taneja, No Financial Disclosure Information; No Product/Research Disclosure Information