Hospital-acquired venous thromboembolism among critically ill children with diabetic ketoacidosis: A single-center experience

Abstract

Hospital-acquired venous thromboembolism (HA-VTE) rates and risk factors unique to critically ill children with diabetic ketoacidosis (DKA) are poorly described. We aimed to characterize the degree of acidosis, hyperglycemia, dehydration, and impaired mentation at presentation among children with DKA with and without subsequent HA-VTE development. In a single-center retrospective cohort study, we estimated the HA-VTE rate among children <21 years of age hospitalized for DKA over 3 years. In addition to characterizing VTE, we recorded the frequency and magnitude of previously described prothrombotic risk factors and DKA-specific markers, including blood pH, β-hydroxybutyrate, bicarbonate, and glucose; Glasgow Coma Scale (GCS); and calculated per cent dehydration. Of 386 patients studied, only two (0.5%) developed HA-VTE, both of which were central venous catheter-related deep venous thrombosis. The patients with HA-VTE had a pH of 6.8, β-hydroxybutyrate of 9.6 and 8.5 mmol/L, glucose of 1298 and 808 mg/dL, GCS of 8 and 3, and moderate to severe dehydration, respectively. Among critically ill children and young adults hospitalized for DKA, the frequency of HA-VTE was 0.5%, occurring in patients with greater illness severity and a concurrent central venous catheter.