title: The impact of deep vein thrombosis in critically ill patients: a meta-analysis of major clinical outcomes.
abstract: BACKGROUND
  Critically ill patients appear to be at high risk of developing deep vein thrombosis (DVT) and pulmonary embolism during their stay in the intensive care unit (ICU). However, little is known about the clinical course of venous thromboembolism in the ICU setting. We therefore evaluated, through a systematic review of the literature, the available data on the impact of a diagnosis of DVT on hospital and ICU stay, duration of mechanical ventilation and mortality in critically ill patients. We also tried to determine whether currently adopted prophylactic measures need to be revised and improved in the ICU setting.
  
  
  METHODS
  MEDLINE and EMBASE databases were searched up to week 4 of June 2012. Two reviewers selected studies and extracted data. Pooled results are reported as relative risks and weighted mean differences and are presented with 95% confidence intervals (CI).
  
  
  RESULTS
  Seven studies for a total of 1,783 patients were included. A diagnosis of DVT was frequent in these patients with a mean rate of 12.7% (95% CI: 8.7-17.5%). DVT patients had longer ICU and hospital stays compared to those without DVT (7.28 days; 95% CI: 1.4-13.15; and 11.2 days; 95% CI: 3.82-18.63 days, respectively). The duration of mechanical ventilation was significantly increased in DVT patients (weighted mean difference: 4.85 days; 95% CI: 2.07-7.63). DVT patients had a marginally significant increase in the risk of hospital mortality (relative risk 1.31; 95% CI: 0.99-1.74; p=0.06), and a not statistically significant increase in the risk of ICU mortality (RR 1.64; 95% CI: 0.91-2.93; p=0.10).
  
  
  CONCLUSIONS
  A diagnosis of DVT upon ICU admission appears to affect clinically important outcomes including duration of ICU and hospital stay and hospital mortality. Larger, prospective studies are warranted.
authors.affiliation: Chair and Unit of Haematology and Transplantation, University Hospital of Palermo, Palermo, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Malato
authors.affiliation: Department of Internal Medicine, University of Insubria, Varese, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Dentali
authors.affiliation: Chair and Unit of Haematology and Transplantation, University Hospital of Palermo, Palermo, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Siragusa
authors.affiliation: Division of Haematology and Bone Marrow Transplantation, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Fabbiano
authors.affiliation: Applied Science and Engineering, University of Toronto, Toronto, Canada.
authors.forename: Yoan
authors.initials: Y
authors.lastname: Kagoma
authors.affiliation: General and Specialist Medicine, Medical and Surgical Critical Care Department, Careggi University Hospital, Florence, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Boddi
authors.affiliation: General and Specialist Medicine, Medical and Surgical Critical Care Department, Careggi University Hospital, Florence, Italy.
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
authors.affiliation: Anaesthesia and Intensive Care Unit of the Emergency Department, Careggi University Hospital, Florence, Italy.
authors.forename: Adriano
authors.initials: A
authors.lastname: Peris
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Crowther
authors.affiliation: Chair and Unit of Haematology and Transplantation, University Hospital of Palermo, Palermo, Italy.
authors.forename: Mariasanta
authors.initials: M
authors.lastname: Napolitano
mesh_terms: D015331:Cohort Studies; D016638:Critical Illness; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012306:Risk; D019851:Thrombophilia / Q000209:etiology; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control / Q000628:therapy