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Zhou J, Zhu Y, Liu Y, Zhan H, Niu P, Chen H, Zhang J. Proportion and risk factors for hospital-acquired venous thromboembolism in children: a systematic review and meta-analysis of data from 20 million individuals in 22 countries. Res Pract Thromb Haemost 2024; 8:102541. [PMID: 39398295 PMCID: PMC11470410 DOI: 10.1016/j.rpth.2024.102541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/22/2024] [Accepted: 07/30/2024] [Indexed: 10/15/2024] Open
Abstract
Background Hospital-acquired venous thromboembolism (HA-VTE) in children has been widely regarded. Objectives We aimed to analyze the proportion and risk factors for HA-VTE in hospitalized children. Methods We conducted a comprehensive systematic search across 4 databases from 1990 to 2023. Cochran Q test was used to evaluate the heterogeneity of the effect sizes of study, and I2 statistic was used to quantify the heterogeneity. Pooled estimates were calculated by the inverse-variance weighted method in a fixed-effect model or a random-effect model when heterogeneity was low (I2 < 25%) or high (I2 > 25%), respectively. Results In total, 105 original papers and 20,718,294 patients were included in the study, and the proportion of HA-VTE in children was 4.1% (95% CI, 2.9%-5.2%). Although the proportion of venous thromboembolism increased over the various research periods, the differences were not statistically significant. In the subgroup analysis based on country, the proportion of pediatric HA-VTE was lowest in the United Kingdom and highest in Spain, whereas when based on region, the proportion was lowest in Asia and highest in North America. Multiple HA-VTE risk factors were identified, including central venous catheter use, age of >10 years, surgery, injury, infection, obesity, mechanical ventilation, blood transfusion, malignancy, coagulation and hemorrhagic disorders, and length of hospital stay. Conclusion In this study, we systematically analyzed the proportion and risk factors of HA-VTE in hospitalized children. Our findings provide valuable insights for the prevention and treatment of HA-VTE in pediatric patients.
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Affiliation(s)
- Jintuo Zhou
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Yanting Zhu
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Ying Liu
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Hairong Zhan
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Peiguang Niu
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Huajiao Chen
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Jinhua Zhang
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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Güler S, Temuroğlu A, Sezgin Evim M, Meral Günes A. Incidence and Management of Thromboembolism in Patients with Acute Leukemia. Indian J Hematol Blood Transfus 2023; 39:642-648. [PMID: 37786830 PMCID: PMC10542053 DOI: 10.1007/s12288-023-01642-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 03/16/2023] [Indexed: 03/31/2023] Open
Abstract
Thromboembolic events (TE) in childhood are relatively rare but, serious complications of acute leukemia. The aim was to define the incidence and risk factors of thrombosis in children with leukemias. The electronic files of pediatric denovo/relapsed acute leukemia patients aged below 18 years, treated between 2011 and 2021 were retrospectively evaluated for thrombotic attacks. Thirty out of 469 patients developed 35 thrombotic events. The median age at the time of the TE was 11.8 (2-17.6) years, and the median time from diagnosis to TE was 9 (0-58) months. The frequency of TE was found at 7.4% (n = 35/469). When catheter related (n = 13) events, superficial venous events (n = 10), and arterial central nervous system thrombosis (n = 1) were excluded, the frequency of TE was decreased to 2.3% (n = 11/469). Children older than 10 years old (13.8%; n = 21/152) had significantly higher thromboembolic events than the others (4.4%; n = 14/317) (p = 0.03). The majority of attacks were symptomatic 66% (n = 23/35). The most common complaints were local pain, swelling, and redness 52% (n = 12/23). The majority of attacks in patients with relapsed (75%; 6/8) and newly diagnosed acute lymphoblastic leukemia (40%; 10/25%) developed during the induction phase. Thrombosis recurred in 13.3% (n = 4/30) of cases more than once. Thrombotic attacks were successfully treated with low molecular weight heparin 60% (n = 21/35), and recombinant tissue plasminogen activator 17% (n = 6/35). None of the children were lost due to thrombosis. Thrombosis is an important complication during acute leukemia treatment. Successful results are obtained with early diagnosis and treatment attempts by creating awareness.
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Affiliation(s)
- Salih Güler
- Department of Pediatric Hematology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Aytül Temuroğlu
- Department of Pediatric Hematology, Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Melike Sezgin Evim
- Department of Pediatric Hematology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Adalet Meral Günes
- Department of Pediatric Hematology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
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Qiu K, Liao X, Li Y, Huang K, Xu H, Fang J, Zhou D. Real-World Presentation and Prognostic Effect of Allogeneic Blood Transfusion during the Intensive Induction Phase in Pediatric Acute Lymphoblastic Leukemia. Cancers (Basel) 2023; 15:4462. [PMID: 37760431 PMCID: PMC10526786 DOI: 10.3390/cancers15184462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Purpose: To determine associations between allogeneic blood transfusion (ABT) during the intensive induction phase of therapy and prognostic effect in a real-world cohort of pediatric patients with acute lymphoblastic leukemia (ALL). Methods: A total of 749 pediatric patients who were diagnosed with ALL were enrolled in this study by using a single-center retrospective cohort study method from February 2008 to May 2022. Results: Among the ABT patients, 711 (94.9%) children were transfused with packed red blood cells (PRBCs), 434 (57.9%) with single-donor platelets (SDPs), and 196 (26.2%) with fresh frozen plasma (FFP). Our multivariate analysis demonstrated that FFP transfusion was the unique independent factor that affected both relapse-free survival (RFS) and overall survival (OS). The transfusion of FFP was significantly associated with higher age (p < 0.001), being more likely to receive SCCLG-ALL-2016 protocol (p < 0.001), higher proportion of more than 25 blood product transfusions, more PRBC transfusion (p < 0.001), and higher D33-MRD-positive rates (p = 0.013). Generalized additive models and threshold effect analysis using piece-wise linear regression were applied to identify the cut-off value of 25 mL/kg for average FFP transfusion. K-M survival analysis further confirmed that average FFP transfusion > 25 mL/kg was an independent adverse indicator of inferior outcome in terms of RFS (p = 0.027) and OS (p = 0.033). Conclusions: In blood products, only FFP supplement is closely related to the prognosis of childhood ALL. During the intensive induction phase, the indications of FFP transfusion should be strictly grasped, and the total amount of FFP should be controlled and kept below 25 mL/kg.
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Affiliation(s)
- Kunyin Qiu
- Department of Hematology/Oncology, Children’s Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China; (K.Q.); (X.L.); (Y.L.); (K.H.); (H.X.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Xiongyu Liao
- Department of Hematology/Oncology, Children’s Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China; (K.Q.); (X.L.); (Y.L.); (K.H.); (H.X.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Yang Li
- Department of Hematology/Oncology, Children’s Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China; (K.Q.); (X.L.); (Y.L.); (K.H.); (H.X.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Ke Huang
- Department of Hematology/Oncology, Children’s Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China; (K.Q.); (X.L.); (Y.L.); (K.H.); (H.X.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Honggui Xu
- Department of Hematology/Oncology, Children’s Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China; (K.Q.); (X.L.); (Y.L.); (K.H.); (H.X.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Jianpei Fang
- Department of Hematology/Oncology, Children’s Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China; (K.Q.); (X.L.); (Y.L.); (K.H.); (H.X.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Dunhua Zhou
- Department of Hematology/Oncology, Children’s Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China; (K.Q.); (X.L.); (Y.L.); (K.H.); (H.X.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
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Campos LR, Petroli M, Sztajnbok FR, da Costa ES, Brandão LR, Land MGP. Risk factors for the development of hospital-acquired pediatric venous thromboembolism-Dealing with potentially causal and confounding risk factors using a directed acyclic graph (DAG) analysis. PLoS One 2020; 15:e0242311. [PMID: 33186402 PMCID: PMC7665816 DOI: 10.1371/journal.pone.0242311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/01/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction Hospital-acquired venous thromboembolism (HA-VTE) in children comprises multiple risk factors that should not be evaluated separately due to collinearity and multiple cause and effect relationships. This is one of the first case-control study of pediatric HA-VTE risk factors using a Directed Acyclic Graph (DAG) analysis. Material and methods Retrospective, case-control study with 22 cases of objectively confirmed HA-VTE and 76 controls matched by age, sex, unit of admission, and period of hospitalization. Descriptive statistics were used to define distributions of continuous variables, frequencies, and proportions of categorical variables, comparing cases and controls. Due to many potential risk factors of HA-VTE, a directed acyclic graph (DAG) model was created to identify confounding, reduce bias, and increase precision on the analysis. The final model consisted of a DAG-informed conditional logistic regression. Results In the initial conventional univariable model, the following variables were selected as potential risk factors for HA-VTE: length of stay (LOS, days), immobility, ICU admission in the last 30 days, LOS in ICU, infection, central venous catheter (CVC), number of CVCs placed, L-asparaginase, heart failure, liver failure, and nephrotic syndrome. The final model using the set of variables selected by DAG analysis revealed LOS (OR = 1.106, 95%CI = 1.021–1.198, p = 0.013), L-asparaginase (OR = 26.463, 95%CI = 1.609–435.342, p = 0.022), and nephrotic syndrome (OR = 29.127, 95%CI = 1.044–812.508, p = 0.004) as independent risk factors for HA-VTE. Conclusion The DAG-based approach was useful to clarify the influence of confounders and multiple causalities of HA-VTE. Interestingly, CVC placement—a known thrombotic risk factor highlighted in several studies—was considered a confounder, while LOS, L-asparaginase use and nephrotic syndrome were confirmed as risk factors to HA-VTE. Large confidence intervals are related to the sample size; however, the results were significant.
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Affiliation(s)
- Leonardo Rodrigues Campos
- Department of Pediatrics, Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Pediatrics, Division of Pediatric Rheumatology, Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói - Rio de Janeiro, Brazil
| | - Maurício Petroli
- Department of Pediatrics, Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Pediatrics, Faculty of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Flavio Roberto Sztajnbok
- Department of Pediatrics, Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Pediatrics, Faculty of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Pediatrics, Division of Pediatric Rheumatology, Hospital Universitário Pedro Ernesto, Rio de Janeiro, Brazil
| | - Elaine Sobral da Costa
- Department of Pediatrics, Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Pediatrics, Faculty of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonardo Rodrigues Brandão
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Marcelo Gerardin Poirot Land
- Department of Pediatrics, Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Pediatrics, Faculty of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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