1095: VENOUS THROMBOEMBOLISM IN HOSPITALIZED CHILDREN WITH NEPHROTIC SYNDROME

Abstract

Introduction: Urinary loss of anticoagulant proteins, altered fibrinolysis, and intravascular fluid depletion as well as abnormalities in platelet aggregation and increased synthesis of prothrombotic factors in children with nephrotic syndrome (NS) are responsible for increased risk of venous thromboembolism (VTE). This study aimed to delineate national epidemiological data on hospitalized pediatric patients with NS and VTE. Methods: We performed a cross-sectional analysis utilizing the Kids’ Inpatient Database for the years 2016 and 2019. Children from birth to 20 years of age with a discharge diagnosis of NS were included. Predictors included demographic data and comorbidities. Outcomes included VTE, mortality, length of stay and resource use. Chi-square test, student t-test and multiple logistic regression were used for inferential statistical comparisons. Results: There were 10,934 discharges with NS out of a total of 12,157,889 (8.9 per 10,000 discharges) during the study period. A diagnosis of VTE was present in 193 discharges (1.8%) in the NS cohort. Among children with NS, there was no difference in gender, race/ethnicity or median household income between those with and without VTE. Acute pulmonary embolism occurred in 0.7% of all NS discharges and accounted for 42% of VTE among children with NS and VTE. Multiple logistic regression, adjusted for hypercoagulable conditions, revealed that the risk of VTE in children with NS was significantly more than in the general population (aOR 3.7; 95% CI: 3.2-4.4). Among children with NS, the presence of VTE was associated with an increased mortality rate (OR 5.9; 95%CI: 2.0-16.8) and longer mean LOS (16.8 days; 95% CI: 12.8-20.8 vs. 5.2 days; 95% CI: 5.0-5.4). Additionally, among children with NS, those with VTE were more likely to need hemodialysis/peritoneal dialysis (OR 3.5; 95% CI: 2.1-5.6), renal biopsy (OR 1.8; 95% CI: 1.1-2.7), mechanical ventilation (OR 6.2; 95% CI: 3.6-10.4), and were more likely to have AKI (OR 2.6; 95% CI: 1.8- 3.9), CKD (OR 1.7; 95% CI: 1.0-2.7), ESRD (OR 2.3; 95% CI: 1.5-4.1), and hypercoagulable conditions exclusive of NS (OR 14.0; 95% CI: 9.2-21.2). Conclusions: Children with NS are at higher risk for VTE. VTE is associated with increased morbidity, mortality and resource utilization in children with NS.