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Original Research: Critical Care |

VTE Incidence and Risk Factors in Patients With Severe Sepsis and Septic ShockVTE Incidence in Severe Sepsis and Septic Shock

David Kaplan, MD; T. Charles Casper, PhD; C. Gregory Elliott, MD; Shaohua Men, MS; Robert C. Pendleton, MD; Larry W. Kraiss, MD; Andrew S. Weyrich, PhD; Colin K. Grissom, MD; Guy A. Zimmerman, MD; Matthew T. Rondina, MD
Author and Funding Information

From the Department of Internal Medicine (Drs Kaplan, Pendleton, Weyrich, Grissom, Zimmerman, and Rondina), the Study Design and Biostatistics Center (Dr Casper), the Molecular Medicine Program (Drs Weyrich and Rondina and Mr Men), Eccles Institute of Human Genetics, and the Division of Vascular Surgery (Dr Kraiss), University of Utah, Salt Lake City; and the Division of Pulmonary and Critical Care Medicine (Drs Elliott and Grissom), Department of Medicine, Intermountain Medical Center, Murray, UT.

CORRESPONDENCE TO: Matthew T. Rondina, MD, University of Utah, Department of Internal Medicine, 50 North Medical Dr, Room 4B120, Salt Lake City, UT 84132; e-mail: matthew.rondina@hsc.utah.edu


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)].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(5):1224-1230. doi:10.1378/chest.15-0287
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BACKGROUND:  Prospective studies on the incidence of VTE during severe sepsis and septic shock remain absent, hindering efficacy assessments regarding VTE prevention strategies in sepsis.

METHODS:  We prospectively studied 113 consecutively enrolled patients in the ICU with severe sepsis and septic shock at three hospitals. All patients provided informed consent. VTE thromboprophylaxis was recorded for all patients. Patients underwent ultrasonography and were followed for VTE prior to ICU discharge. All-cause 28-day mortality was recorded. Variables from univariate analyses that were associated with VTE (including central venous catheter [CVC] insertion, age, length of stay, and mechanical ventilation) were included in a multivariable logistic regression analysis using backward stepwise elimination to determine VTE predictors.

RESULTS:  Mean APACHE (Acute Physiology and Chronic Health Evaluation) II score was 18.2 ± 7.0, and age was 50 ± 18 years. Despite all patients receiving guideline-recommended thromboprophylaxis, the incidence of VTE was 37.2% (95% CI, 28.3-46.8). Most VTE events were clinically significant (defined as pulmonary embolism, proximal DVT, and/or symptomatic distal DVT) and associated with an increased length of stay (18.2 ± 9.9 days vs 13.4 ± 11.5 days, P < .05). Mortality was higher in patients with acute VTE but did not reach statistical significance. Insertion of a CVC and longer mechanical ventilation duration were significant VTE risk factors. VTE incidence did not differ by thromboprophylaxis type.

CONCLUSIONS:  To our knowledge this is the first multicenter prospective study to identify a high incidence of VTE in patients with severe sepsis and septic shock, despite the use of universal, guideline-recommended thromboprophylaxis. Our findings suggest that the systemic inflammatory milieu of sepsis may uniquely predispose patients with sepsis to VTE. More effective VTE prevention strategies are necessary in patients with sepsis.

TRIAL REGISTRY:  ClinicalTrials.gov; No.: NCT02353910; URL: www.clinicaltrials.gov

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