Risk factors associated with in-hospital mortality in critically ill elderly patients with venous thromboembolism


  • Anju Puri Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
  • Mohan Giri Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
  • Manoj Oli Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
  • Qinghua Zhao Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China




VTE, MIMIC-IV, In-hospital mortality, Risk factors


Background: Venous thromboembolism (VTE) is a major cause of morbidity and mortality for patients admitted to the intensive care unit (ICU). The present study aims to investigate the risk factors for in-hospital mortality among critically ill elderly patients with VTE.

Methods: This was a retrospective cohort study utilizing data from the large medical information mart for intensive care IV (MIMIC-IV) database. All elderly patients diagnosed with VTE were included in the analysis. The analyses were conducted using SPSS version 26.0 software and MedCalc version 19.6. Univariable and multivariable logistic regression models were conducted to explore potential risk factors associated with in-hospital mortality.

Results: The study population had a median age of 75 years, with a range from 69.0 to 82.0 years, and males represented 50.4% of the cohort. Among critically ill VTE patients, the in-hospital mortality rate was 18.5% (237 out of 1282). Multivariable regression analysis revealed that longer ICU stays [OR: 1.034; 95% CI: 1.010-1.059, p=0.005], higher Charlson comorbidity index (CCI) scores [OR: 1.090; 95% CI: 1.001-1.187, p=0.046], elevated simplified acute physiology score II (SAPS II scores) [OR: 1.039; 95% CI: 1.023-1.056, p<0.001], increased red blood cell distribution width (RDW) levels [OR: 1.088; 95% CI: 1.006-1.178, p=0.035], lower mean arterial pressure (MAP) [OR: 0.975; 95% CI: 0.957-0.994, p=0.011], presence of severe liver disease [OR: 2.036; 95% CI: 1.051-3.941, p=0.035], and the necessity for renal replacement therapy (RRT) [OR: 2.478; 95% CI: 1.315-4.671, p=0.005] were significantly associated with an increased risk of in-hospital mortality among elderly ICU patients with VTE.

Conclusions: The study identifies numerous independent risk factors associated with in-hospital mortality among critically ill elderly patients with VT. These factors include prolonged length of ICU stay, elevated scores on the CCI and SAPS II, increased RDW, reduced MAP, the presence of severe liver disease, and the necessity for RRT.


Gao X, Zeng L, Wang H, Zeng S, Tian J, Chen L, et al. Prevalence of Venous Thromboembolism in Intensive Care Units: A Meta-Analysis. J Clin Med. 2022;11(22):6691.

Malato A, Dentali F, Siragusa S, Fabbiano F, Kagoma Y, Boddi M, et al. The impact of deep vein thrombosis in critically ill patients: a meta-analysis of major clinical outcomes. Blood Transfus. 2015;13(4):559-68.

Cook D, Meade M, Guyatt G, Walter S, Heels-Ansdell D, Warkentin TE, et al. Dalteparin versus unfractionated heparin in critically ill patients. N Engl J Med. 2011;364(14):1305-14.

Beitland S, Wimmer H, Lorentsen T, Jacobsen D, Draegni T, Brunborg C, et al. Venous thromboembolism in the critically ill: A prospective observational study of occurrence, risk factors and outcome. Acta Anaesthesiol Scand. 2019;63(5):630-8.

Lutsey PL, Zakai NA. Epidemiology and prevention of venous thromboembolism. Nat Rev Cardiol. 2023;20(4):248-62.

Ruppert A, Steinle T, Lees M. Economic burden of venous thromboembolism: a systematic review. J Med Econ. 2011;14(1):65-74.

Spyropoulos AC, Lin J. Direct medical costs of venous thromboembolism and subsequent hospital readmission rates: an administrative claims analysis from 30 managed care organizations. J Manag Care Pharm. 2007;13(6):475-86.

Al Eidan FAS, AlManea RK, AlMoneef AT, Shalash NA, AlRajhi NA, AlMousa SF, et al. Incidence and Predictors of Recurrence and Mortality Following First Venous Thromboembolism Among the Saudi Population: Single-Center Cohort Study. Int J Gen Med. 2022;15:7559-68.

Robertson L, Yeoh SE, Stansby G, Agarwal R. Effect of testing for cancer on cancer- and venous thromboembolism (VTE)-related mortality and morbidity in people with unprovoked VTE. Cochrane database Syst Rev. 2017;8(8):CD010837.

Faller N, Limacher A, Méan M, Righini M, Aschwanden M, Beer JH, et al. Predictors and Causes of Long-Term Mortality in Elderly Patients with Acute Venous Thromboembolism: A Prospective Cohort Study. Am J Med. 2017;130(2):198-206.

Johnson AEW, Bulgarelli L, Shen L, Gayles A, Shammout A, Horng S, et al. MIMIC-IV, a freely accessible electronic health record dataset. Sci Data. 2023;10(1):1.

Cohen SL, Gianos E, Barish MA, Chatterjee S, Kohn N, Lesser M, et al. Prevalence and Predictors of Venous Thromboembolism or Mortality in Hospitalized COVID-19 Patients. Thromb Haemost. 2021;121(8):1043-53.

Gussoni G, Frasson S, La Regina M, Di Micco P, Monreal M. Three-month mortality rate and clinical predictors in patients with venous thromboembolism and cancer. Findings from the RIETE registry. Thromb Res. 2013;131(1):24-30.

Nicholson M, Chan N, Bhagirath V, Ginsberg J. Prevention of Venous Thromboembolism in 2020 and Beyond. J Clin Med. 2020;9(8):2467.

Cushman M. Epidemiology and risk factors for venous thrombosis. Semin Hematol. 2007;44(2):62-9.

Moitra VK, Guerra C, Linde-Zwirble WT, Wunsch H. Relationship Between ICU Length of Stay and Long-Term Mortality for Elderly ICU Survivors. Crit Care Med. 2016;44(4):655-62.

Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173(6):676-82.

Ng ACC, Chow V, Yong ASC, Chung T, Kritharides L. Prognostic impact of the Charlson comorbidity index on mortality following acute pulmonary embolism. Respiration. 2013;85(5):408-16.

Zöller B, Pirouzifard M, Sundquist J, Sundquist K. Association of Short-Term Mortality of Venous Thromboembolism with Family History of Venous Thromboembolism and Charlson Comorbidity Index. Thromb Haemost. 2019;119(1):48-55.

Yang Y, Yang KS, Hsann YM, Lim V, Ong BC. The effect of comorbidity and age on hospital mortality and length of stay in patients with sepsis. J Crit Care. 2010;25(3):398-405.

Clarke B, Howlett J, Sapp J, Andreou P, Parkash R. The effect of comorbidity on the competing risk of sudden and nonsudden death in an ambulatory heart failure population. Can J Cardiol. 2011;27(2):254-61.

Choi MJ, Ha SO, Kim HS, Park S, Han SJ, Lee SH. The Simplified Acute Physiology Score II as a Predictor of Mortality in Patients Who Underwent Extracorporeal Membrane Oxygenation for Septic Shock. Ann Thorac Surg. 2017;103(4):1246-53.

Le Gall JR, Neumann A, Hemery F, Bleriot JP, Fulgencio JP, Garrigues B, et al. Mortality prediction using SAPS II: an update for French intensive care units. Crit Care. 2005;9(6):R645-52.

Xu F, Li W, Zhang C, Cao R. Performance of Sequential Organ Failure Assessment and Simplified Acute Physiology Score II for Post-Cardiac Surgery Patients in Intensive Care Unit. Front Cardiovasc Med. 2021;8:774935.

Kim K Il, Lee HS, Kim HS, Ha SO, Lee WY, Park SJ, et al. The pre-ECMO simplified acute physiology score II as a predictor for mortality in patients with initiation ECMO support at the emergency department for acute circulatory and/or respiratory failure: a retrospective study. Scand J Trauma Resusc Emerg Med. 2015;23:59.

Shen R, Gao M, Tao Y, Chen Q, Wu G, Guo X, et al. Prognostic nomogram for 30-day mortality of deep vein thrombosis patients in intensive care unit. BMC Cardiovasc Disord. 2021;21(1):11.

Wang F, Pan W, Pan S, Ge J, Wang S, Chen M. Red cell distribution width as a novel predictor of mortality in ICU patients. Ann Med. 2011;43(1):40-6.

Muhlestein JB, Lappe DL, Anderson JL, Muhlestein JB, Budge D, May HT, et al. Both initial red cell distribution width (RDW) and change in RDW during heart failure hospitalization are associated with length of hospital stay and 30-day outcomes. Int J Lab Hematol. 2016;38(3):328-37.

Otero TMN, Canales C, Yeh DD, Hou PC, Belcher DM, Quraishi SA. Elevated red cell distribution width at initiation of critical care is associated with mortality in surgical intensive care unit patients. J Crit Care. 2016;34:7-11.

Fujita B, Franz M, Figulla H-R, Pfeifer R, Kabisch B, Fritzenwanger M, et al. Red cell distribution width and survival in patients hospitalized on a medical ICU. Clin Biochem. 2015;48(16-17):1048-52.

Ellingsen TS, Lappegård J, Skjelbakken T, Brækkan SK, Hansen J-B. Red cell distribution width is associated with incident venous thromboembolism (VTE) and case-fatality after VTE in a general population. Thromb Haemost. 2015;113(1):193-200.

Grainger BT, Paul E, Nanjayya V, Tran H, Pilcher D, McFadyen JD. Long-Term Outcomes of Pulmonary Embolism Requiring Intensive Care Unit (ICU) Admission. Blood. 2023;142:1271.

Barba R, Gonzalvez-Gasch A, Joya Seijo D, Marco J, Canora J, Plaza S, et al. Venous thromboembolism in patients with liver diseases. J Thromb Haemost. 2018;16(10):2003-7.

Buresi M, Hull R, Coffin CS. Venous thromboembolism in cirrhosis: a review of the literature. Can J Gastroenterol. 2012;26(12):905-8.

Mo S, Bjelland TW, Nilsen TIL, Klepstad P. Acute kidney injury in intensive care patients: Incidence, time course, and risk factors. Acta Anaesthesiol Scand. 2022;66(8):961-8.

Shawwa K, Ghosh E, Lanius S, Schwager E, Eshelman L, Kashani KB. Predicting acute kidney injury in critically ill patients using comorbid conditions utilizing machine learning. Clin Kidney J. 2021;14(5):1428-35.

Kuo T-H, Li H-Y, Lin S-H. Acute kidney injury and risk of deep vein thrombosis and pulmonary embolism in Taiwan: A nationwide retrospective cohort study. Thromb Res. 2017;151:29-35.

Lu H-Y, Liao K-M. Increased risk of deep vein thrombosis in end-stage renal disease patients. BMC Nephrol. 2018;19(1):204.

Elseviers MM, Lins RL, Van der Niepen P, Hoste E, Malbrain ML, Damas P, et al. Renal replacement therapy is an independent risk factor for mortality in critically ill patients with acute kidney injury. Crit Care. 2010;14(6):R221.




How to Cite

Puri, A., Giri, M., Oli, M., & Zhao, Q. (2024). Risk factors associated with in-hospital mortality in critically ill elderly patients with venous thromboembolism. International Journal of Research in Medical Sciences, 12(5), 1384–1391. https://doi.org/10.18203/2320-6012.ijrms20240953



Original Research Articles