Hospital acquired venous thromboembolism (HA-VTE) among critically ill children with diabetic ketoacidosis: a multicenter, retrospective cohort study.

Abstract

ObjectivesChildren hospitalized for diabetic ketoacidosis (DKA) may be at increased risk of hospital-acquired venous thromboembolism (HAVTE). We sought to estimate the incidence of HAVTE and identify unique prothrombotic risk factors in this population. MethodsWe performed a multicenter, retrospective cohort study used the Pediatric Health Information Systems registry including patients aged 0-21 years hospitalized for DKA from January of 2017 through December of 2023 within 48 participating centers. The primary outcome was the frequency of HA-VTE. Secondary outcomes were rates of cerebral edema, central venous catheterization (CVC), invasive mechanical ventilation (IMV), infection, and length of stay (LOS). An adjusted logistic regression was employed to identify potential HAVTE risk factors. ResultsOf the 27,613 patients studied, 93 (0.3%) developed a HAVTE. Compared to those without HAVTE, those with had a greater median LOS (10 [interquartile range (IQR): 5-21] versus 2 [IQR: 2-3] days) and rates of cerebral edema (25.8% versus 6.6%), CVC (23.7% versus 1.1%), infection (72% versus 23.5%), and IMV (39.8% versus 1.4%) (all p<0.001). In an adjusted logistic model, factors independently associated with increased HAVTE were CVC (adjusted odds ratio [aOR]: 3.04, 95% confidence interval [CI]: 1.49-6.19), infection (aOR: 4.61, 95%CI: 2.81-7.56), IMV (aOR: 9.24, 95%CI: 4.83-17.56), and increasing LOS (aOR: 1.05, 95%CI: 1.02-1.06) (all p<0.01). ConclusionThe frequency of HAVTE among critically ill children and young adults hospitalized for DKA was 0.3%. After prospective validation, putative risk factors (i.e., CVC, IMV, infection, and extended LOS) may be incorporated in the design of forthcoming pediatric thromboprophylaxis trials.