Mortality Associated with Venous Thromboembolism in Hospitalized Pediatric Patients: A Single Tertiary Care Institute Experience

Abstract

▪Background: Hospital-associated venous thromboembolism (HA-VTE) is a major cause of morbidity and mortality in adults; there is a paucity of data about mortality risk in children.Objective: To determine clinical factors associated with mortality in children with HA-VTE.Methods: We conducted retrospective chart review of patients <=21 years with HA-VTE admitted to the Johns Hopkins Hospital from 1992-2013. ICD-9 codes were used to identify cases with deep venous thrombosis and pulmonary embolism; diagnosis was verified by reviewing hospital records and radiologic imaging. HA-VTE was defined as 1) VTE diagnosed ≥48 hours after hospital admission or 2) VTE diagnosed within 90 days of hospital discharge. Univariate and conditional multivariable logistic regression analyses with backward elimination were used to estimate the risk factors for mortality and adjusted Odds Ratios (adjOR) calculated.Results: Of 330 HA-VTE cases, there were 55 deaths (16.7%); 18 deaths (5.5%) were attributable to VTE. Median follow up was 2.9 years. Within 30 days of VTE diagnosis, all-cause mortality was 4.2% and VTE-attributable mortality was 1.8%. Acute systemic infection (adjOR 11.3; 95%CI 4.7-26.8) and malignancy (adjOR 3.9; 95%CI 1.6-9.5) were associated with increased adjusted odds of all-cause mortality (Table 1). For deaths specifically attributable to VTE, acute systemic infection (adjOR 18.6; 95%CI 4.9-71.4) was associated with increased adjusted odds of mortality.Conclusion: The majority of VTE-attributable deaths occurred over 30 days from VTE diagnosis. Acute systemic infection was a significant predictor of VTE-related mortality in HA-VTE. Further studies are warranted to identify additional risks for VTE-related mortality to develop prevention strategies.Table 1Odds Ratio Estimates of All-cause Mortality in Hospital Associated Venous Thromboembolism in Children in a Tertiary Care Hospital.Putative Risk FactorOdds Ratio95% WaldConfidence Limits*Systemic Infection11.34.726.8Cancer3.91.69.5Pulmonary Embolism0.70.32.0Age (each year increase)0.90.91.1Male gender versus female0.70.31.5Central Venous Catheter1.40.63.2Hospital readmission within 90 days1.50.63.7*Meningitis, abscess, pneumonia, osteomyelitis, bacteremia, fungemia, and pyelonephritis DisclosuresTakemoto:Novo Nordisk: Research Funding; Mast Therapeutics: Speakers Bureau.