Venous thromboembolism in severe pediatric intestinal failure
Abstract:
Objective: To quantify the rate of venous thromboembolism (VTE) in patients with pediatric intestinal failure (PIF) and identify associated risk factors.
Study design: We performed a retrospective cohort study in pediatric patients (<21 years old) with severe PIF (≥90 consecutive days of PN) secondary to short bowel syndrome who were treated from 2014 to 2021 at an interdisciplinary intestinal rehabilitation program. The primary outcome was the incidence of VTE. Multivariable regression was performed to identify independent clinical predictors of VTE.
Results: A total of 263 (59.7% male) patients met criteria for inclusion. Cumulative incidence of VTE was 28.1% with a rate of 0.32 VTEs/1000 catheter-days. On univariate analysis, number of catheter days, number of catheters, and history of central line-associated blood stream infection (CLABSI) were associated with VTE. On multivariable logistic regression, higher number of catheters was an independent risk factor for VTE (aOR 1.17; 95%CI 1.06, 1.29). Additionally, earlier gestational age was a risk factor for VTE such that every week decrease in gestational age conferred a 9% increased risk of VTE (aOR 1.09; 95%CI 1.02, 1.16).
Conclusion: In this retrospective study, 28.1% of patients with severe PIF developed VTE; number of catheters and early gestational age were noted to be independent risk factors for VTE. This high incidence of VTE highlights the need to prospectively investigate VTE in PIF, including the potential benefit of prophylactic anticoagulation.
Reference:
Keefe G, Culbreath K, Staffa SJ, Carey AN, Jaksic T, Kumar R, Modi BP. High Rate of Venous Thromboembolism in Severe Pediatric Intestinal Failure. J Pediatr. 2022 Sep 28:S0022-3476(22)00856-3. doi: 10.1016/j.jpeds.2022.09.034. Epub ahead of print. PMID: 36181872.