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Diabetic Ketoacidosis and Venous Thromboembolism: A North American Virtual Pediatric Systems Registry Study,
Kristin M DeMayo1, Elizabeth E Havlicek2, Jamie Palumbo3
1Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, FL.
Insights
The occurrence rate of venous thromboembolism (VTE) in critically ill children with diabetic ketoacidosis (DKA) was 0.29%. Central venous catheterization and concurrent infection/sepsis were identified as significant risk factors for VTE in this population.
Area of Science:
- Pediatric Critical Care Medicine
- Thrombosis and Hemostasis
- Endocrinology
Background:
- Diabetic ketoacidosis (DKA) is a serious complication of diabetes in children and young adults.
- Critically ill patients are at increased risk for venous thromboembolism (VTE).
- Limited data exist on VTE occurrence and risk factors in critically ill pediatric patients with DKA.
Purpose of the Study:
- To determine the incidence of VTE in critically ill children and young adults admitted with DKA.
- To identify potential risk factors associated with VTE development in this cohort.
- To evaluate the association of DKA severity and common interventions with VTE.
Main Methods:
- Multicenter, observational, retrospective cohort study.
- Data extracted from the Virtual Pediatric Systems database (October 2014 - December 2023).
- Included critically ill patients aged >30 days to <21 years with DKA, excluding neonates and post-cardiac surgery patients.
Main Results:
- A total of 21,549 DKA encounters were analyzed; 62 (0.29%) developed VTE.
- Patients with VTE had higher rates of sepsis, cerebral edema, central venous catheterization (CVC), mechanical ventilation, and longer length of stay (LOS).
- More severe acidosis, hyperglycemia, and lower Glasgow Coma Scale scores were associated with VTE; CVC and concurrent sepsis/infection were independent risk factors (aOR 23.27 and 6.69, respectively).
Conclusions:
- The estimated VTE occurrence rate in critically ill pediatric patients with DKA is 0.29%.
- Central venous catheterization and concurrent infection/sepsis are significantly associated with VTE in this population.
- These findings highlight the need for vigilance and potential preventative strategies in high-risk DKA patients.
Objectives:
To estimate the occurrence rate of venous thromboembolism (VTE) among critically ill children and young adults with diabetic ketoacidosis (DKA) and evaluate putative prothrombotic risk factors using a multicenter data registry.
Design:
Multicenter, observational, retrospective study utilizing a cohort derived from the Virtual Pediatric Systems database from October 1, 2014, to December 31, 2023.
Setting:
One hundred thirty-nine North American PICUs.
Patients:
Critically ill children and young adults older than 30 days to younger than 21 years old with principal admission diagnosis of DKA, excluding neonates, postcardiac surgical patients, and children with length of stay (LOS) less than 1 day.
Interventions:
None.
Measurements And Main Results:
Of 21,549 encounters, 62 (0.29%) developed VTE (mean annual rate, 0.29% ± 0.06%) and 32 of 62 (55%) were hospital-acquired VTE. Patients with, as compared to without, VTE experienced greater rates of sepsis (43.6% vs. 0.7%), cerebral edema (17.7% vs. 3.1%), central venous catheterization (CVC: 66.1% vs. 3.8%), invasive mechanical ventilation (46.8% vs. 2.3%), and a greater LOS (median, 4.9 d [interquartile range (IQR), 2.6-12.2 d] vs. 1.4 d [IQR, 1.1-1.9 d]; all p < 0.001). Regarding DKA-specific prothrombotic risk factors, those with (as compared to without) VTE had more severe acidosis (median admission pH, 6.96 [IQR, 6.82-7.13] vs. 7.07 [IQR, 6.96-7.18]), hyperglycemia (median, 590 mg/dL [IQR, 453-834 mg/dL] vs. 406 mg/dL [IQR, 310-548 mg/dL]), and reduced Glasgow Coma Scale scores (median, 12 [IQR, 6-14] vs. 15 [IQR, 14-15]; all p < 0.001). In an adjusted model, the presence of a CVC (adjusted odds ratio, 23.27; 95% CI, 6.63-81.6; p < 0.001) and concurrent sepsis/infection (odds ratio, 6.69; 95% CI, 2.37-18.87; p < 0.001) were associated with VTE.
Conclusions:
In this multicenter observational study of critically ill children and young adults hospitalized with DKA, the estimated occurrence rate of VTE was 0.29% and, in an adjusted model, associated with CVC and concurrent infection/sepsis.
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