Objectives. We compared venous thromboembolism (VTE) prophylaxis practices and incidence in critically ill cirrhotic versus noncirrhotic patients and evaluated cirrhosis as a VTE risk factor. Methods. A cohort of 798 critically ill patients followed for the development of clinically detected VTE were categorized according to the diagnosis of cirrhosis. VTE prophylaxis practices and incidence were compared. Results. Seventy-five (9.4%) patients had cirrhosis with significantly higher INR (2.2 ± 0.9 versus 1.3 ± 0.6, P < 0.0001), lower platelet counts (115,000 ± 90,000 versus 258,000 ± 155,000/μL, P < 0.0001), and higher creatinine compared to noncirrhotic patients. Among cirrhotics, 31 patients received only mechanical prophylaxis, 24 received pharmacologic prophylaxis, and 20 did not have any prophylaxis. Cirrhotic patients were less likely to receive pharmacologic prophylaxis (odds ratio, 0.08; 95% confidence interval (CI), 0.04–0.14). VTE occurred in only two (2.7%) cirrhotic patients compared to 7.6% in noncirrhotic patients (P = 0.11). The incidence rate was 2.2 events per 1000 patient-ICU days for cirrhotic patients and 3.6 events per 1000 patient-ICU days for noncirrhotics (incidence rate ratio, 0.61; 95% CI, 0.15–2.52). On multivariate Cox regression analysis, cirrhosis was not associated with VTE risk (hazard ratio, 0.40; 95% CI, 0.10–1.67). Conclusions. In critically ill cirrhotic patients, VTE incidence did not statistically differ from that in noncirrhotic patients.
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机译:目标。我们比较了重症肝硬化和非肝硬化患者的静脉血栓栓塞(VTE)预防措施和发生率,并评估了肝硬化作为VTE的危险因素。方法。根据临床肝硬化的诊断,对根据临床检测到的VTE发展而随访的798名危重患者进行了分类。比较了VTE的预防措施和发生率。结果。七十五名(9.4%)肝硬化患者的INR显着较高(2.2±0.9 vs 1.3±0.6,P <0.0001),血小板计数较低(115,000±90,000 vs 258,000±155,000 /μL,P <0.0001),肌酐较高与非肝硬化患者相比。在肝硬化患者中,仅接受机械预防的患者31例,接受药物预防的患者24例,没有进行预防的20例。肝硬化患者接受药物预防的可能性较小(优势比为0.08; 95%置信区间(CI)为0.04-0.14)。 VTE仅发生在两个肝硬化患者中(2.7%),而非肝硬化患者中的发生率为7.6%(P = 0.11)。肝硬化患者的发病率是每1000个患者-ICU天2.2个事件,非肝硬化患者的发病率是每1000个患者-ICU天3.6个事件(发生率比,0.61; 95%CI,0.15-2.52)。在多因素Cox回归分析中,肝硬化与VTE风险无关(危险比,0.40; 95%CI,0.10-1.67)。结论。在重症肝硬化患者中,VTE发生率与非肝硬化患者无统计学差异。
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