Venous Thromboembolism after Community-Acquired Bacteraemia: A 20-year Danish Cohort Study

Abstract

BackgroundInfections may increase the risk for venous thromboembolism (VTE), but little is known about VTE risk associated with community-acquired bacteraemia (CAB). We examined the risk for VTE within one year of CAB in comparison to that in matched controls.MethodsWe conducted a population-based cohort study in North Denmark 1992–2011, using data from high-quality health-care databases. We included 4,213 adult CAB patients who had positive blood cultures drawn on the day of hospital admission, 20,084 matched hospitalised controls admitted for other acute medical illness, and 41,121 matched controls from the general population. We computed 0–90 and 91–365 day absolute risks for hospital-diagnosed VTE and used regression analyses with adjustment for confounding factors to compare the risk for VTE in bacteraemia patients and controls.ResultsAmong CAB patients, 1.1% experienced VTE within 90 days of admission and 0.5% during 91–365 days after admission. The adjusted 90-day odds ratio (OR) for VTE was 1.9 (95% CI 1.4–2.7) compared with hospitalised controls, and 23.4 (95% CI 12.9–42.6) compared with population controls. During 91–365 days after CAB admission, the VTE risk remained moderately increased (adjusted hazard ratio vs. hospitalised controls, 1.4; 95% CI 0.8–2.5, and vs. population controls, 1.9; 95% CI 1.0–3.3). Compared to hospitalised controls, the 90-day VTE risk increase was greater for Gram-positive infection (adjusted OR 2.5; 95% CI 1.6–4.1) than for Gram-negative infection (adjusted OR, 1.2; 95% CI 0.7–2.1), partly due to a high risk after Staphylococcus aureus infection (3.6%).ConclusionThe risk for VTE is substantially increased within 90 days after community-acquired bacteraemia when compared to hospitalised controls and population controls. However, the absolute risk of VTE following CAB is low.

Functional status and quality of life after community-acquired bacteraemia: a matched cohort study

“…Community-acquired bacteraemia is a severe acute disease that may entail devastating physical and psychological stress on the afflicted patients. During the acute infection, patients may experience disseminated intravascular coagulation, renal injury, acute cardiovascular events and other complications that can have a lasting effect on individuals' health [23][24][25][26]. Moreover, patients with severe infection may experience myopathy and muscle atrophy with prolonged limb and respiratory muscle weakness [27].…”

Acute infection as a trigger for incident venous thromboembolism: Results from a population‐based case‐crossover study

“…Established risk factors like active cancer, major surgery, central venous catheter and acute medical conditions, including acute infections, all contribute to the increased risk of VTE in relation to hospitalization 4. Acute infections are associated with increased risk of VTE in both hospitalized and non‐hospitalized patients 5, 6, 7…”

“…4 Acute infections are associated with increased risk of VTE in both hospitalized and non-hospitalized patients. [5][6][7] In most observational study designs, confounding remains a methodological challenge. This is also the case when studying the relationship between infection and VTE, where for instance immobilization can act both as a confounder and as an intermediate in the causal pathway.…”

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“…Long term follow-up for mortality was reported in seven of the ten studies with the duration of follow-up ranging from 1 to 12 years (18)(19)(20)(21)(22)(23)(24). Mortality was measured at variable intervals within the follow-up period with one month the most commonly reported mortality time point other than one year (19)(20)(21)24).…”