Association of Obesity and Pediatric Venous Thromboembolism

Halvorson, Elizabeth E.; Ervin, Sean; Russell, Thomas; Skelton, Joseph A.; Davis, Stephen; Spangler, John G.

doi:10.1542/hpeds.2015-0039

Cited by 20 publications

(9 citation statements)

References 19 publications

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“…In contrast, formula-fed infants displayed an ongoing maturation of adaptive immunity cells and a delayed recruitment of innate immunity cells as compared with breast-fed infants 24. Obesity is a well-established risk factor for venous thromboembolism in adults in contrary to children 25. Taken these together, our finding and the above reports suggest different pathophysiologic background between adult obesity and children obesity.…”

Section: Discussionsupporting

confidence: 48%

A Study of Fecal Calprotectin in Obese Children and Adults

Park

Kim

2018

JOMES

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Background Obesity is a complex, medical condition causally contributing to many chronic diseases and a number of efforts have been made to find the associated markers for novel prevention and treatment of obesity. Our study was to evaluate the relationship between gut immune response and obesity and overweight with use of fecal calprotectin (FC) both in adult and children groups. Methods Fecal samples were obtained from 74 subjects: 14 non-obese and overweight children (PN), 13 obese and overweight children (PO), 20 non-obese and overweight adults (AN), and 27 obese and overweight adults (AO). FC was measured using a commercial Legend Max quantitative enzyme-linked immunosorbent assay (BioLegend). Mann-Whitney U -test was used for statistical analysis. Results Median FC concentration was 7.9 μg/g (range, 1.9–28.9 μg/g) for PN, 5.0 μg/g (range, 2.6–29.6 μg/g) for PO, 9.5 μg/g (range, 0.8–28.9 μg/g) for AN, and 10.0 μg/g (range, 1.6–25.6 μg/g) for AO, respectively. In both adults and children age groups, the FC showed no statistically significant difference between AO and AN or PO and PN. However, FC showed statistically significant difference ( P <0.05) between AO and PO while not significant between AN and PN. Conclusion FC level in AO was significantly higher than that in PO, suggestive of different pathophysiologic mechanism between children obesity and adults obesity.

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Section: Discussionsupporting

confidence: 48%

A Study of Fecal Calprotectin in Obese Children and Adults

Park

Kim

2018

JOMES

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“…43 Obesity has also been associated with an increased risk of deep vein thrombosis. 19 In thermally injured obese children, the LOS and respiratory interventions were increased but not the mortality rate. 44 Obesity has been associated with an increased risk of abdominal injuries, especially of the liver, but without an increase in the requirement for operative management.…”

Section: Discussionmentioning

confidence: 99%

“…18 In a single-institution study, incidence of deep vein thrombosis was greater in obese children. 19 In a recent multisite study of ventilated children, both low and high BMI were associated with adverse outcomes, with higher mortality in underweight children. 20 Preoperative malnutrition (low BMI) was associated with worse outcomes in children after surgery for congenital heart disease, possibly due to poor myocardial function in malnourished children.…”

Section: Introduction/backgroundmentioning

confidence: 99%

The impact of body mass index on resource utilization and outcomes of children admitted to a pediatric intensive care unit

2019

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Introduction:Obesity is associated with poor health outcomes but may be protective in intensive care unit patients. The objective of this study is to describe the characteristics of underweight, normal weight, and obese children, and to compare their length of stay, resource utilization, and mortality.Methods:The charts of 1447 patients who were admitted to a tertiary-level pediatric intensive care unit during 1 calendar year were reviewed. Patients were divided into three groups: underweight (<5th percentile), normal (5th–95th percentiles), and obese (>95th percentile). Body mass index for age percentile was used for children older than age 2 years, and weight-for-height percentile was used for children younger than age 2 years. Demographic data, Pediatric Index of Mortality 2 score, Pediatric Index of Mortality 2 risk of mortality, hospital mortality, hospital length of stay, the use and duration of ventilator support, hemodynamic support, and dialysis were determined.Results:Fifteen percent of children were underweight, while 61.5% were normal weight and 23.5% were obese; 54.9% of the patients were male. The overall mortality was 1.87%, with no significant difference between the three weight groups. The racial distribution, prevalence, and duration of invasive and noninvasive ventilation, and the use of vasopressors, central venous lines, and dialysis were similar between three groups. Tube feeding and parenteral nutrition were used more often in the underweight group. Pediatric intensive care unit and hospital lengths of stays were higher in underweight children. Underweight children were younger when compared to normal or obese children. Pediatric Index of Mortality 2 scores and Pediatric Index of Mortality 2 risk of mortality scores were higher in underweight children.Conclusion:There were no significant differences between the three weight groups in mortality. Underweight children were younger and sicker, and received tube feeding and parenteral nutrition more frequently.

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“…Presence of other risk factors of VTE, including hospitalisation, pregnancy and use of combined oestrogen–progestin hormonal contraceptives, increases VTE risk in obese patients and exacerbates the severity of VTE [72–74]. An association between elevated BMI and VTE risk has also been recently identified in paediatric patients [75]. Despite greater understanding, a number of questions remain unanswered concerning a definition of high-risk subpopulations who are obese and who may benefit from thromboprophylaxis, the choice of anticoagulants and selection of optimal regimens for thromboprophylaxis, and treatment of VTE in obese patients.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of unmet clinical needs in prophylaxis and treatment of venous thromboembolism in at-risk patient groups: pregnancy, elderly and obese patients

et al. 2019

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BackgroundVenous thromboembolism (VTE) accounts for an estimated 900,000 cases per year in the US alone and constitutes a considerable burden on healthcare systems across the globe.ObjectiveTo understand why the burden is so high, qualitative and quantitative research was carried out to gain insights from experts, guidelines and published studies on the unmet clinical needs and therapeutic strategies in VTE prevention and treatment in three populations identified as being at increased risk of VTE and in whom VTE prevention and treatment were regarded as suboptimal: pregnant women, the elderly and obese patients.MethodologyA gap analysis methodology was created to highlight unmet needs in VTE management and to discover the patient populations considered most at risk. A questionnaire was devised to guide qualitative interviews with 44 thrombosis and haemostasis experts, and a review of the literature on VTE in the specific patient groups from 2015 to 2017 was completed. This was followed by a Think Tank meeting where the results from the research were discussed.ResultsThis review highlights the insights gained and examines in detail the unmet needs with regard to VTE risk-assessment tools, biomarkers, patient stratification methods, and anticoagulant and dosing regimens in pregnant women, the elderly and obese patients.ConclusionsSpecifically, in pregnant women at high risk of VTE, low-molecular-weight heparin (LMWH) is the therapy of choice, but it remains unclear how to use anticoagulants when VTE risk is intermediate. In elderly patients, evaluation of the benefit of VTE prophylaxis against the bleeding risk is particularly important, and a head-to-head comparison of efficacy and safety of LMWH versus direct oral anticoagulants is needed. Finally, in obese patients, lack of guidance on anticoagulant dose adjustment to body weight has emerged as a major obstacle in effective prophylaxis and treatment of VTE.

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Association of Obesity and Pediatric Venous Thromboembolism

Abstract: In this single-institution study, the diagnosis of VTE was significantly associated with overweight and obesity. Further study is needed to fully define this association.

Cited by 20 publications

References 19 publications

A Study of Fecal Calprotectin in Obese Children and Adults

A Study of Fecal Calprotectin in Obese Children and Adults

The impact of body mass index on resource utilization and outcomes of children admitted to a pediatric intensive care unit

Evaluation of unmet clinical needs in prophylaxis and treatment of venous thromboembolism in at-risk patient groups: pregnancy, elderly and obese patients

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