Clin Respir J. 2026 Sep;20(9):e70230. doi: 10.1111/crj.70230.
ABSTRACT
INTRODUCTION: High-altitude exposure and hypoxia may induce a hypercoagulable state, thereby promoting the development of venous thromboembolism (VTE). Few studies have reported the incidence of VTE among patients with severe community-acquired pneumonia (SCAP) in high-altitude regions. We conducted a study to investigate the prevalence, risk factors, prognosis, and potential thromboprophylaxis strategies of VTE in this patient population.
METHODS: We prospectively enrolled 158 adult patients with SCAP admitted to Lhasa People's Hospital between January 1, 2023, and December 31, 2024. All patients underwent lower extremity venous compression ultrasound and/or computed tomography pulmonary angiography examination. Clinical characteristics, including demographic information, medical history, vital signs, laboratory findings, treatments, complications, and clinical outcomes, were compared for patients with and without VTE in these two subgroups.
RESULTS: Of the 158 patients, 74 (46.8%) developed VTE, including 68 with DVT, 21 with pulmonary embolism (PE) and 15 with both DVT and PE. A total of 123 (77.8%) patients received VTE prophylaxis, and there was no significant difference in the incidence of VTE among the groups with different prophylactic measures (p = 0.838). Multivariate logistic regression analysis showed an association between lower partial pressure of arterial oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio (PaO2/FiO2 ratios ≤ 160 mmHg: odds ratio [OR] = 2.354, 95% confidence interval [CI] 1.025-5.406, p = 0.044), higher D-dimer level (D-dimer levels ≥ 3.0 μg/mL: OR = 2.901, 95% CI 1.329-6.334; p = 0.008), longer bedridden time (bedridden times ≥ 3 days: OR = 3.540, 95% CI 1.494-8.391, p = 0.004), and the occurrence of VTE. A new prediction model including PaO2/FiO2 ratios, D-dimer levels, and bedridden times showed a better performance in predicting VTE (AUC = 0.886; 95% CI 0.826-0.931; sensitivity: 74.3%; specificity: 89.3%) than Padua prediction score (AUC = 0.624) and Caprini prediction score (AUC = 0.622) for patients with SCAP at high-altitude areas (all p < 0.05). The calibration curve of the nomogram model shows good predictive value. The 30-day cumulative survival rate of patients with VTE was significantly lower than that of patients without VTE (p = 0.034).
CONCLUSIONS: The prevalence of VTE is unexpectedly high in hospitalized patients with SCAP in high-altitude regions and may be associated with a poor prognosis. Early identification of patients at high risk for VTE and optimization of thromboprophylactic strategies are therefore warranted improve patient outcomes.
PMID:42723341 | DOI:10.1111/crj.70230