Risk Factors for Pulmonary Embolism in ICU Patients: A Retrospective Cohort Study from the MIMIC-III Database

Abstract

Pulmonary embolism (PE) is a common and potentially lethal form of venous thromboembolic disease in ICU patients. A limited number of risk factors have been associated with PE in ICU patients. In this study, we aimed to screen the independent risk factors of PE in ICU patients that can be used to evaluate the patient's condition and provide targeted treatment. We performed a retrospective cohort study using a freely accessible critical care database Medical Information Mart for Intensive Care (MIMIC)-III. The ICU patients were divided into two groups based on the incidence of PE. Finally, 9871 ICU patients were included, among which 204 patients (2.1%) had pulmonary embolism. During the multivariate logistic regression analysis, sepsis, hospital_LOS (the length of stay in hospital), type of admission, tumor, APTT (activated partial thromboplastin time) and platelet were independent risk factors for patients for PE in ICU, with OR values of 1.471 (95%CI 1.001-2.162), 1.001 (95%CI 1.001-1.001), 3.745 (95%CI 2.187-6.414), 1.709 (95%CI 1.247-2.341), 1.014 (95%CI 1.010-1.017) and 1.002 (95%CI 1.001-1.003) ( Ps < 0.05). ROC curve analysis showed that the composite indicator had a higher predictive value for ICU patients with PE, with a ROC area under the curve (AUC) of 0.743 (95%CI 0.710 −0.776, p < 0.001). Finally, sepsis, tumor, platelet count, length of stay in the hospital, emergency admission and APTT were independent predictors of PE in ICU patients.

Risk factors and prognosis of hospital-acquired VTE in patients with sepsis

“…Wang et al [19] also showed that mechanical ventilation and length of hospital stay were correlated with hospital-acquired VTE. In a study of risk factors for VTE in critically ill patients, length of hospitalization was also a risk factor for VTE [20,21]. We concluded that VTE was correlated with the severity of sepsis; however, the SOFA score and lactic acid level were not found to be independent risk factors for VTE.…”

The burden and predictors of venous thromboembolic diseases in patients with multiple primary malignancies

“…Critically ill patients are at increased risk for VTE due to their comorbidities, reason of admission such as multi-organ failure, sepsis, and trauma, prolonged immobilization which is further potentiated by sedation, central or peripheral venous catheterization, and invasive procedures. [56][57][58][59] It is known that patients with MPMs, compared to single malignancy, 60 and synchronous malignancy, compared with metachronous malignancy, have worse survival. 28,[61][62][63] Initially, malignancy weakens the immune system, but subsequently triggers the immune system via the cytokines and the release of growth factors, resulting eventually in an exhausted and weak immune system.…”

“…Critically ill patients are at increased risk for VTE due to their comorbidities, reason of admission such as multi‐organ failure, sepsis, and trauma, prolonged immobilization which is further potentiated by sedation, central or peripheral venous catheterization, and invasive procedures. 56 , 57 , 58 , 59 …”

“…Although more than half of the patients admitted to the ICU received prophylactic anticoagulants in the form of enoxaparin or unfractionated heparin, ICU admission was identified as a predictor of VTE ( p = .003). Critically ill patients are at increased risk for VTE due to their comorbidities, reason of admission such as multi‐organ failure, sepsis, and trauma, prolonged immobilization which is further potentiated by sedation, central or peripheral venous catheterization, and invasive procedures 56–59 …”

Association between statin use and acute pulmonary embolism in intensive care unit patients with sepsis: a retrospective cohort study

“…The increased incidence of APE observed in critically ill patients is attributed to various factors, including complete immobilization, reluctance to administer anticoagulant prophylaxis due to a heightened risk of bleeding, and impaired peripheral circulation in patients receiving vasopressor drugs to sustain central blood pressure, thereby leading to reduced subcutaneous heparin bioavailability ( 3 , 4 ). Furthermore, sepsis is a notable stand alone risk factor for the development of APE ( 5 – 7 ). The initial phases of sepsis involve a multitude of concurrent pathophysiological mechanisms, encompassing inflammation and activation of coagulation pathways ( 8 ).…”