title: VTE Incidence and Risk Factors in Patients With Severe Sepsis and Septic Shock.
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.
  
  
  BACKGROUND
  ClinicalTrials.gov; No.: NCT02353910; URL: www.clinicaltrials.gov.
authors.affiliation: Department of Internal Medicine, University of Utah, Salt Lake City.
authors.forename: David
authors.initials: D
authors.lastname: Kaplan
authors.affiliation: Study Design and Biostatistics Center, University of Utah, Salt Lake City.
authors.forename: T Charles
authors.initials: TC
authors.lastname: Casper
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, UT.
authors.forename: C Gregory
authors.initials: CG
authors.lastname: Elliott
authors.affiliation: Molecular Medicine Program, University of Utah, Salt Lake City.
authors.forename: Shaohua
authors.initials: S
authors.lastname: Men
authors.affiliation: Department of Internal Medicine, University of Utah, Salt Lake City.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Pendleton
authors.affiliation: Eccles Institute of Human Genetics, and the Division of Vascular Surgery, University of Utah, Salt Lake City.
authors.forename: Larry W
authors.initials: LW
authors.lastname: Kraiss
authors.affiliation: Department of Internal Medicine, University of Utah, Salt Lake City; Molecular Medicine Program, University of Utah, Salt Lake City.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Weyrich
authors.affiliation: 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.
authors.forename: Colin K
authors.initials: CK
authors.lastname: Grissom
authors.affiliation: Department of Internal Medicine, University of Utah, Salt Lake City.
authors.forename: Guy A
authors.initials: GA
authors.lastname: Zimmerman
authors.affiliation: 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.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Rondina
mesh_terms: D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D018805:Sepsis / Q000150:complications*; D012772:Shock, Septic / Q000150:complications*; D015996:Survival Rate / Q000639:trends; D014589:Utah / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000209:etiology