title: [Venous thromboembolism in critically ill patients: analysis of the main age-related risk factors and definition of specific scores.]
abstract: BACKGROUND
  Venous thromboembolism (VTE) is the third most common cardiovascular illness after acute coronary syndrome and stroke and and the most common preventable cause of hospital-related death. Several studies have demonstrated a significant reduction of fatal pulmonary embolism attributed to the introduction of thromboprophylactic measures and changes in hospital practices. However, the influence of some demographical variables, especially age, has largely been under appreciated.
  
  
  METHODS
  Using the date of the TEVere study, we have studied 187 patients with VTE and 350 case-control, and we proceeded to analyze the major risk factors for venous thromboembolism, separately for three age groups (≤60 years, 60-75 years, >75 years). Patients came from the departments of internal medicine and emergency medicine for 21 hospitals. In this subgroup, we have examined the main risk factors for the individual classes of age and have proposed, through a logistic regression analysis, 3 different types of scores, specific for each age class. We then compared the individual scores obtained with the Kucher's score.
  
  
  RESULTS
  It was found that in the class of patients with a lower age of 60, the main risk factors found to be estrogen-progestagen treatment (p=0.004) and family history of VTE (p=0.047), while in older patients (>75 years) the main risk factors were immobilization (p=0.005) and chronic venous insufficiency (p=0.001). In common for the three classes the presence of an evolutionary malignancy and previous episodes of VTE. Through the ROC curve analysis, it was found that the results for the three proposed scores improved sensitivity compared to Kucher's score. However our results showed that the only score of the intermediate class showed a statistically significant difference for prediction of the thromboembolic risk (p=0.0264 (AUROC 0.7946; 95% CI, 0.75 to 0.80, AUROC 0.7042; 95% CI, 0.68. to 0.72).
  
  
  CONCLUSIONS
  Our study emphasizes the importance of carrying a correct stratification, which also consider the patient's age and therefore the concomitant pathologies. In fact, although the age of the patient cannot be considered as the only criterion to start the thromboprophylaxis, as highlighted in literature, you need to consider each individual patient, with its own peculiarities.
  
  
  CONCLUSIONS
  This study showed the difficulty in identifying the key risk factors that are responsible for thromboembolic disease and has emerged the opportunity to be evaluated by larger studies, the use of specific scores by age groups.
authors.affiliation: Dipartimento di Emergenza e Accettazione, USL UMBRIA1, Assisi (Perugia).
authors.forename: Manuel
authors.initials: M
authors.lastname: Monti
authors.affiliation: Dipartimento di Emergenza e Accettazione, Ospedale Fatebenefratelli - Isola Tiberina, Roma.
authors.forename: Giovanni Maria
authors.initials: GM
authors.lastname: Vincentelli
authors.affiliation: Dipartimento di Emergenza e Accettazione, USL UMBRIA1, Assisi (Perugia).
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Murdolo
authors.affiliation: Dipartimento di Emergenza e Accettazione, Policlinico Umberto I, Sapienza Università di Roma.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Bertazzoni
authors.affiliation: Dipartimento di Emergenza e Accettazione, Ospedale Sandro Pertini, Roma.
authors.forename: Francesco Rocco
authors.initials: FR
authors.lastname: Pugliese
authors.affiliation: Dipartimento di Emergenza e Accettazione, Ospedale Fatebenefratelli - Isola Tiberina, Roma.
authors.forename: Francesco
authors.initials: F
authors.lastname: Borgognoni
authors.affiliation: Dipartimento di Emergenza e Accettazione, Ospedale San Giovanni Addolorata, Roma.
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Ruggieri
authors.affiliation: Medicina Interna, Università "Cattolica", Policlinico Gemelli, Roma.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Landolfi
mesh_terms: D000367:Age Factors; D000368:Aged; D016638:Critical Illness; D006801:Humans; D011655:Pulmonary Embolism; D012307:Risk Factors; D054556:Venous Thromboembolism