.2015 Nov;148(5):1224-1230.

doi: 10.1378/chest.15-0287.

VTE Incidence and Risk Factors in Patients With Severe Sepsis and Septic Shock

David Kaplan¹, T Charles Casper², C Gregory Elliott³, Shaohua Men⁴, Robert C Pendleton¹, Larry W Kraiss⁵, Andrew S Weyrich⁶, Colin K Grissom⁷, Guy A Zimmerman¹, Matthew T Rondina⁸

Affiliations

¹ Department of Internal Medicine, University of Utah, Salt Lake City.
² Study Design and Biostatistics Center, University of Utah, Salt Lake City.
³ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, UT.
⁴ Molecular Medicine Program, University of Utah, Salt Lake City.
⁵ Eccles Institute of Human Genetics, and the Division of Vascular Surgery, University of Utah, Salt Lake City.
⁶ Department of Internal Medicine, University of Utah, Salt Lake City; Molecular Medicine Program, University of Utah, Salt Lake City.
⁷ Department of Internal Medicine, University of Utah, Salt Lake City; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, UT.
⁸ Department of Internal Medicine, University of Utah, Salt Lake City; Molecular Medicine Program, University of Utah, Salt Lake City. Electronic address: matthew.rondina@hsc.utah.edu.

PMID:26111103
PMCID: PMC4631038
DOI: 10.1378/chest.15-0287

VTE Incidence and Risk Factors in Patients With Severe Sepsis and Septic Shock

David Kaplan et al. Chest.2015 Nov.

.2015 Nov;148(5):1224-1230.

doi: 10.1378/chest.15-0287.

Authors

David Kaplan¹, T Charles Casper², C Gregory Elliott³, Shaohua Men⁴, Robert C Pendleton¹, Larry W Kraiss⁵, Andrew S Weyrich⁶, Colin K Grissom⁷, Guy A Zimmerman¹, Matthew T Rondina⁸

Affiliations

¹ Department of Internal Medicine, University of Utah, Salt Lake City.
² Study Design and Biostatistics Center, University of Utah, Salt Lake City.
³ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, UT.
⁴ Molecular Medicine Program, University of Utah, Salt Lake City.
⁵ Eccles Institute of Human Genetics, and the Division of Vascular Surgery, University of Utah, Salt Lake City.
⁶ Department of Internal Medicine, University of Utah, Salt Lake City; Molecular Medicine Program, University of Utah, Salt Lake City.
⁷ Department of Internal Medicine, University of Utah, Salt Lake City; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, UT.
⁸ Department of Internal Medicine, University of Utah, Salt Lake City; Molecular Medicine Program, University of Utah, Salt Lake City. Electronic address: matthew.rondina@hsc.utah.edu.

PMID:26111103
PMCID: PMC4631038
DOI: 10.1378/chest.15-0287

Abstract

Background: Prospective studies on the incidence of VTE during severe sepsis and septic shock remain absent, hindering efficacy assessments regarding VTE prevention strategies in sepsis.

Methods: We prospectively studied 113 consecutively enrolled patients in the ICU with severe sepsis and septic shock at three hospitals. All patients provided informed consent. VTE thromboprophylaxis was recorded for all patients. Patients underwent ultrasonography and were followed for VTE prior to ICU discharge. All-cause 28-day mortality was recorded. Variables from univariate analyses that were associated with VTE (including central venous catheter [CVC] insertion, age, length of stay, and mechanical ventilation) were included in a multivariable logistic regression analysis using backward stepwise elimination to determine VTE predictors.

Results: Mean APACHE (Acute Physiology and Chronic Health Evaluation) II score was 18.2 ± 7.0, and age was 50 ± 18 years. Despite all patients receiving guideline-recommended thromboprophylaxis, the incidence of VTE was 37.2% (95% CI, 28.3-46.8). Most VTE events were clinically significant (defined as pulmonary embolism, proximal DVT, and/or symptomatic distal DVT) and associated with an increased length of stay (18.2 ± 9.9 days vs 13.4 ± 11.5 days, P < .05). Mortality was higher in patients with acute VTE but did not reach statistical significance. Insertion of a CVC and longer mechanical ventilation duration were significant VTE risk factors. VTE incidence did not differ by thromboprophylaxis type.

Conclusions: To our knowledge this is the first multicenter prospective study to identify a high incidence of VTE in patients with severe sepsis and septic shock, despite the use of universal, guideline-recommended thromboprophylaxis. Our findings suggest that the systemic inflammatory milieu of sepsis may uniquely predispose patients with sepsis to VTE. More effective VTE prevention strategies are necessary in patients with sepsis.

Trial registry: ClinicalTrials.gov; No.:NCT02353910; URL: www.clinicaltrials.gov.

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Figures

**Figure 1 –**
CONSORT diagram of the study procedures.

**Figure 2 –**
The incidence of VTE among patients (N = 113) with severe sepsis or septic shock. Shown is the incidence of VTE of any type (All VTE) and the individual types of venous thromboembolic events, which include proximal DVT in the upper extremities, proximal DVT in the lower extremities, distal symptomatic DVT, distal asymptomatic DVT, and symptomatic PE. Patients with sepsis may have had one or more thromboses (eg DVT and PE). PE = pulmonary embolism.

See this image and copyright information in PMC

Comment in

Increased Incidence of VTE in Septic Shock: Is this Preventable?
Sorenson CA, McCurdy MT.Sorenson CA, et al.Chest. 2016 Apr;149(4):1107. doi: 10.1016/j.chest.2015.12.040.Chest. 2016.PMID:27055704No abstract available.
Response.
Kaplan D, Rondina MT.Kaplan D, et al.Chest. 2016 Apr;149(4):1107-8.Chest. 2016.PMID:27512739No abstract available.

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VTE Incidence and Risk Factors in Patients With Severe Sepsis and Septic Shock

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