Incidence of venous thromboembolic disease and risk of bleeding in critically ill patients with hematologic malignancies: A retrospective study
Bibliographic record
Abstract
Our objectives were to describe the use of thromboprophylaxis and the incidence of VTE/bleeding in critically ill patients with hematologic malignancies (HM). Retrospective cohort study (2014–2022). Medic-Surgical Intensive Care Unit (ICU) in a tertiary care academic center. Adult patients admitted to ICU with a concomitant diagnosis of a hematological malignancy. None. We analyzed demographic data, use of thromboprophylaxis and secondary outcomes that included incidence of VTE (venous thromboembolism), bleeding, mortality, severity scores and organ support. We applied a multivariable logistic regression model to examine the risk of thrombosis in the ICU. We included 862 ICU admissions (813 unique patients). Thromboprophylaxis was given during 65% of admissions (LMWH 14%, UFH 8%, and SCDs 43%); in 21% it was contraindicated due to thrombocytopenia; 14% of cases lacked documentation on prophylaxis. There were 38 unique incident cases of VTE (27 DVT, 11 PE), constituting 4.4% of ICU episodes. Most of VTE cases happened in patients with various degrees of thrombocytopenia. In the multivariable analysis, SOFA score on the first ICU day was independently associated (OR 0.85, 95% CI 0.76−0.96) with the risk of VTE. Bleeding occurred in 7.2% (minor) and 14.4% (major) of episodes; most frequent sites being CNS, abdomen/GI and pulmonary. In this cohort of critically ill patients with HM, there was considerable variability in the utilization of DVT prophylaxis, with predominant use of SCDs. The incidence of VTE was 4.4% and major bleeding 14%. NCT05396157. Venous Thromboembolism in Hematologic Malignancy and Hematopoietic Cell Transplant Patients: a Retrospective Study ( https://clinicaltrials.gov/ ). Describir el uso de tromboprofilaxis y la incidencia de enfermedad tromboembólica y/o sangrado en pacientes críticos con enfermedad oncohematológica. Estudio retrospectivo de cohorte (2014–2022). Unidad cuidados intensivos medico-quirúrgica de un hospital terciario académico en Toronto, Canadá. Adultos con diagnóstico de enfermedad oncohematológica ingresados en la UCI. Ninguna. Se analizaron los datos demográficos, el tipo de tromboprofilaxis utilizada y el riesgo de sangrado junto con los factores relacionados con éstos. Se aplicó un análisis de regresión logística multivariante para evaluar factores de riesgo para trombosis en la UCI. Se incluyeron 862 episodios de ingreso en la UCI (813 pacientes únicos). Se utilizó tromboprofilaxis en el 65% de los casos (heparina de bajo peso molecular 14%, heparina no fraccionada 8% y medios mecánicos 43%); en el 21% estuvo contraindicado por trombocitopenia y en el 14% de los casos no había documentación sobre profilaxis. Hubo 38 casos incidentes de enfermedad trombo embólica venosa o ETEV (27 trombosis venosa profunda, 11 embolismo pulmonar), lo que constituye el 4,4% de los episodios en la UCI. La mayoría de los casos de ETEV ocurrieron en pacientes con diversos grados de trombocitopenia. La puntuación SOFA en el primer día de UCI se relacionó de forma independiente en el análisis multivariable (OR 0.85, 95% CI 0.76−0.96) con el riesgo de ETEV. Se registró sangrado en el 7,2% (menor) y en el 14,4% (mayor) de los episodios; los sitios más frecuentes fueron el SNC, abdomen/GI y pulmonar. En esta cohorte de pacientes críticos con enfermedad oncohematológica, hubo una variabilidad considerable en la utilización de la profilaxis de la TVP, con un uso predominante de métodos mecánicos. La incidencia de ETEV fue del 4,4% y la de hemorragia mayor del 14%.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".