Performance of Risk Assessment Models for VTE in Patients Who Are Critically Ill Receiving Pharmacologic Thromboprophylaxis: A Post Hoc Analysis of the Pneumatic Compression for Preventing VTE Trial.

Autor:	Al-Dorzi HM; Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia., Arishi H; Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia., Al-Hameed FM; Intensive Care Department, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Kingdom of Saudi Arabia., Burns KEA; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Unity Health Toronto-St Michael's Hospital, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, Toronto, ON, Canada., Mehta S; Department of Medicine, University of Toronto, Toronto, ON, Canada; Medical Surgical ICU, Sinai Health, Toronto, ON, Canada., Jose J; King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia., Alsolamy SJ; Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia., Abdukahil SAI; Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia., Afesh LY; King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia., Alshahrani MS; Department of Emergency and Critical Care Medicine, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia., Mandourah Y; Military Medical Services, Ministry of Defense, Riyadh, Kingdom of Saudi Arabia., Almekhlafi GA; Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia., Almaani M; Department of Pulmonary and Critical Care Medicine, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia., Al Bshabshe A; Department of Critical Care Medicine, King Khalid University, Asir Central Hospital, Abha, Kingdom of Saudi Arabia., Finfer S; The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia., Arshad Z; Department of Anesthesiology and Critical Care, King George's Medical University, Lucknow, India., Khalid I; Critical Care Section, Department of Medicine, King Faisal Specialist Hospital & Research Centre, Jeddah, Kingdom of Saudi Arabia., Mehta Y; Institute of Critical Care and Anaesthesiology, Medanta-The Medicity, Gurgaon, Haryana, India., Gaur A; Intensive Care Department, Gosford Hospital, Gosford, NSW, Australia., Hawa H; Critical Care Medicine Department, King Faisal Specialist Hospital & Research Centre, Jeddah, Kingdom of Saudi Arabia., Buscher H; Department of Intensive Care Medicine, Centre for Applied Medical Research, St. Vincent's Hospital, University of New South Wales, Sydney, NSW, Australia., Lababidi H; Department of Pulmonary and Critical Care Medicine, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia., Al Aithan A; Intensive Care Division, Department of Medicine, King Abdulaziz Hospital, Al Ahsa, Kingdom of Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, Al Ahsa, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Al Ahsa, Kingdom of Saudi Arabia., Al-Dawood A; Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia., Arabi YM; Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia. Electronic address: yaseenarabi@yahoo.com.
Jazyk:	angličtina
Zdroj:	Chest [Chest] 2024 Sep 02. Date of Electronic Publication: 2024 Sep 02.
DOI:	10.1016/j.chest.2024.07.182
Abstrakt:	Background: The diagnostic performance of the available risk assessment models for VTE in patients who are critically ill receiving pharmacologic thromboprophylaxis is unclear. Research Question: For patients who are critically ill receiving pharmacologic thromboprophylaxis, do risk assessment models predict who would develop VTE or who could benefit from adjunctive pneumatic compression for thromboprophylaxis? Study Design and Methods: In this post hoc analysis of the Pneumatic Compression for Preventing VTE (PREVENT) trial, different risk assessment models for VTE (ICU-VTE, Kucher, Intermountain, Caprini, Padua, and International Medical Prevention Registry on VTE [IMPROVE] models) were evaluated. Receiver-operating characteristic curves were constructed, and the sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated. In addition, subgroup analyses were performed evaluating the effect of adjunctive pneumatic compression vs none on the study primary outcome. Results: Among 2,003 patients receiving pharmacologic thromboprophylaxis, 198 (9.9%) developed VTE. With multivariable logistic regression analysis, the independent predictors of VTE were Acute Physiology and Chronic Health Evaluation II score, prior immobilization, femoral central venous catheter, and invasive mechanical ventilation. All risk assessment models had areas under the curve < 0.60 except for the Caprini model (0.64; 95% CI, 0.60-0.68). The Caprini, Padua, and Intermountain models had high sensitivity (> 85%) but low specificity (< 20%) for predicting VTE, whereas the ICU-VTE, Kucher, and IMPROVE models had low sensitivities (< 15%) but high specificities (> 85%). The positive predictive value was low (< 20%) for all studied cutoff scores, whereas the negative predictive value was mostly > 90%. Using the risk assessment models to stratify patients into high- vs low-risk subgroups, the effect of adjunctive pneumatic compression vs pharmacologic prophylaxis alone did not differ across the subgroups (P interaction > .05). Interpretation: The risk assessment models for VTE performed poorly in patients who are critically ill receiving pharmacologic thromboprophylaxis. None of the models identified a subgroup of patients who might benefit from adjunctive pneumatic compression. Clinical Trial Registration: ClinicalTrials.gov; No.: NCT02040103; URL: www. Clinicaltrials: gov. ISRCTN44653506. Competing Interests: Financial/Nonfinancial Disclosures None declared. (Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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