Table 2.

Evidence profile for VTE-related prognostic factors

No. of studiesCertainty assessment domainsOverall certainty in the evidence about this prognostic factorRelative effect (95% CI)
Study designRisk of biasIndirectInconsistentImprecisePublication bias
Age (>60 y vs <60 y)7,25-27,29,31,34,37,39  
 9* Observational Serious† Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 1.34 (95% CI, 1.17-1.55) 
MODERATE 
Sex (male vs female)27,34-37  
 5 Observational Serious Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 1.03 (95% CI, 0.80-1.33) 
MODERATE 
CRP (>10 mg/L vs <10 mg/L)35  
 1 Observational Serious Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 10.10 (95% CI, 1.93-52.85) 
MODERATE 
D-dimer (>500 ng/mL vs <500 ng/mL at baseline; and increase vs no increase)36,39  
 2 Observational Serious† Not serious Not serious Not serious Undetected ⊕⊕⊕○ Categorical: OR, 2.46 (95% CI, 1.19-5.10) 
MODERATE Continuous: OR, 3.45 (95% CI, 2.01-5.92) 
Heart rate (elevated >100 beats per minute vs nonelevated <100 beats per minute)27  
 1 Observational Serious Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 2.48 (95% CI, 1.66-3.71) 
MODERATE 
Thrombocytosis (platelet count >350 × 109/L vs <350 × 109/L)27,28  
 2 Observational Serious Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 2.16 (95% CI, 1.40-3.35) 
MODERATE 
Leukocytosis (WBC ≥11 × 109/L vs <11 × 109/L)27  
 1 Observational Serious Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 1.91 (95% CI, 1.24-2.94) 
MODERATE 
Fever (body temperature >38°C-38.5°C vs <38°C-38.5°C)27,28  
 2 Observational Serious Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 1.88 (95% CI, 1.10-3.21) 
MODERATE 
Leg edema (presence vs absence)28,31  
 2 Observational Serious Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 1.88 (95% CI, 1.23-2.90) 
MODERATE 
Varicose veins (presence vs absence)29,31  
 2 Observational Serious† Not serious Not serious Serious‡ Undetected ⊕⊕○○ OR, 1.53 (95% CI, 0.85-2.76) 
LOW 
Obesity (BMI >30 kg/m2vs <30 kg/m2)27,29,34  
 3 Observational Serious† Not serious Not serious Serious‡ Undetected ⊕⊕○○ OR, 1.34 (95% CI, 0.94-1.91) 
LOW 
Fibrinogen levels (elevated levels >400 mg/dL) vs no elevated levels35  
 1 Observational Serious Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 0.18 (95% CI, 0.04-0.81) 
MODERATE 
BI score ≤9 vs >937,39  
 2 Observational Serious† Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 8.30 (95% CI, 2.70-25.52) 
MODERATE 
Immobility: defined as confinement to bed for >72 h or >7 d or bedridden or nonambulatory (yes vs no)7,26-29,31,37,39  
 8 Observational Serious† Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 3.17 (95% CI, 2.18-4.62) 
MODERATE 
Paresis (yes vs no)7,25,26,37  
 4 Observational Serious Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 2.97 (95% CI, 1.20-7.36) 
MODERATE 
Previous VTE (yes vs no)7,25-27,29-31,36  
 8 Observational Serious† Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 6.08 (95% CI, 3.71-9.97). 
MODERATE 
Thrombophilia (familial or acquired disorder of the hemostatic system; yes vs no)7,25,26,29,34  
 5 Observational Serious† Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 5.88 (95% CI, 2.80-12.35) 
MODERATE 
Malignancy (active malignancy, defined as the presence of cancer on admission or within the past year, vs no active malignancy; and history vs no history of malignancy)7,25-28,30,31,34,36,37  
 10 Observational Serious Not serious Not serious Not serious Undetected ⊕⊕⊕○ Active cancer: OR, 2.65 (95% CI, 1.79-3.91) 
MODERATE History of cancer: OR, 3.20 (95% CI, 2.14-4.79) 
Critical illness: defined as ICU or CCU stay, or need for resuscitation (yes vs no)7,25-27,29,34,36  
 7 Observational Serious† Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 1.65 (95% CI, 1.39-1.95) 
MODERATE 
Infections: including cellulitis, pneumonia, and sepsis (yes vs no)28,31  
 5 Observational Serious† Not serious Not serious Not serious Undetected ⊕⊕⊕○ Any infection: OR, 1.48 (95% CI, 1.16-1.89) 
MODERATE Acute infection: OR, 1.59 (95% CI, 1.23-2.06) 
Sepsis: OR, 1.07 (95% CI, 0.70-1.62) 
Heart failure (HF) (acute HF vs no acute HF; history of HF vs no history of HF)28,29,31,35,36  
 5 Observational Serious Not serious Not serious Serious‡ Undetected ⊕⊕○○ Acute heart failure: OR, 0.82 (95% CI, 0.42-1.60) 
LOW History of heart failure: OR, 2.68 (95% CI, 1.11-6.44) 
Autoimmune disease: including rheumatological diseases and inflammatory diseases (yes vs no)27,29,31,35  
 4 Observational Serious† Not serious Serious Not serious Undetected ⊕⊕○○ OR, 2.33 (95% CI, 1.13-4.83) 
LOW 
CVC (presence vs absence)31,34  
 2 Observational Serious Not serious Serious§ Not serious Undetected ⊕⊕○○ OR, 2.05 (95% CI, 0.74-5.65) 
LOW 
Severe stroke: defined as acute ischemic stroke (yes vs no)29,31,32,36  
 4 Observational Serious† Not serious Not serious Serious‡ Undetected ⊕⊕○○ Acute ischemic stroke: OR, 1.79 (95% CI, 0.77-4.18) 
LOW When stroke was assessed in terms of the NIHSS, we found consistent results. 
Tobacco (current use vs no current use; previous use vs no previous use)35  
 1 Observational Serious Not serious Not serious Serious‡ Undetected ⊕⊕○○ Current tobacco use: OR, 1.59 (95% CI, 0.28-9.03) 
LOW Previous tobacco use: OR, 0.97 (0.24-3.92) 
Hormone use: defined as estrogen intake (yes vs no)31  
 1 Observational Serious Not serious Not serious Serious‡ Undetected ⊕⊕○○ OR, 0.80 (95% CI, 0.36-1.78). 
LOW 
Renal failure(yes vs no)36  
 1 Observational Serious || Not serious Not serious Very Serious‡,# Undetected ⊕○○○ OR, 0.76 (95% CI, 0.18-3.18) 
VERY LOW 
Respiratory failure (yes vs no)27,29,31,36  
 4 Observational Serious† Not serious Not serious Serious‡ Undetected ⊕⊕○○ Any respiratory failure: OR, 1.04 (95% 0.69-1.58). 
LOW Acute respiratory failure: OR, 1.18 (95% CI, 0.76-1.84) 
Chronic respiratory failure: OR, 0.58 (95% 0.30-1.10) 
Coronary artery disease (yes vs no)29,31,36,37  
 4 Observational Serious† Not serious Serious§ Not serious Undetected ⊕⊕○○ OR, 1.01 (95% CI, 0.33-3.09) 
LOW 
No. of studiesCertainty assessment domainsOverall certainty in the evidence about this prognostic factorRelative effect (95% CI)
Study designRisk of biasIndirectInconsistentImprecisePublication bias
Age (>60 y vs <60 y)7,25-27,29,31,34,37,39  
 9* Observational Serious† Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 1.34 (95% CI, 1.17-1.55) 
MODERATE 
Sex (male vs female)27,34-37  
 5 Observational Serious Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 1.03 (95% CI, 0.80-1.33) 
MODERATE 
CRP (>10 mg/L vs <10 mg/L)35  
 1 Observational Serious Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 10.10 (95% CI, 1.93-52.85) 
MODERATE 
D-dimer (>500 ng/mL vs <500 ng/mL at baseline; and increase vs no increase)36,39  
 2 Observational Serious† Not serious Not serious Not serious Undetected ⊕⊕⊕○ Categorical: OR, 2.46 (95% CI, 1.19-5.10) 
MODERATE Continuous: OR, 3.45 (95% CI, 2.01-5.92) 
Heart rate (elevated >100 beats per minute vs nonelevated <100 beats per minute)27  
 1 Observational Serious Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 2.48 (95% CI, 1.66-3.71) 
MODERATE 
Thrombocytosis (platelet count >350 × 109/L vs <350 × 109/L)27,28  
 2 Observational Serious Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 2.16 (95% CI, 1.40-3.35) 
MODERATE 
Leukocytosis (WBC ≥11 × 109/L vs <11 × 109/L)27  
 1 Observational Serious Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 1.91 (95% CI, 1.24-2.94) 
MODERATE 
Fever (body temperature >38°C-38.5°C vs <38°C-38.5°C)27,28  
 2 Observational Serious Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 1.88 (95% CI, 1.10-3.21) 
MODERATE 
Leg edema (presence vs absence)28,31  
 2 Observational Serious Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 1.88 (95% CI, 1.23-2.90) 
MODERATE 
Varicose veins (presence vs absence)29,31  
 2 Observational Serious† Not serious Not serious Serious‡ Undetected ⊕⊕○○ OR, 1.53 (95% CI, 0.85-2.76) 
LOW 
Obesity (BMI >30 kg/m2vs <30 kg/m2)27,29,34  
 3 Observational Serious† Not serious Not serious Serious‡ Undetected ⊕⊕○○ OR, 1.34 (95% CI, 0.94-1.91) 
LOW 
Fibrinogen levels (elevated levels >400 mg/dL) vs no elevated levels35  
 1 Observational Serious Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 0.18 (95% CI, 0.04-0.81) 
MODERATE 
BI score ≤9 vs >937,39  
 2 Observational Serious† Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 8.30 (95% CI, 2.70-25.52) 
MODERATE 
Immobility: defined as confinement to bed for >72 h or >7 d or bedridden or nonambulatory (yes vs no)7,26-29,31,37,39  
 8 Observational Serious† Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 3.17 (95% CI, 2.18-4.62) 
MODERATE 
Paresis (yes vs no)7,25,26,37  
 4 Observational Serious Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 2.97 (95% CI, 1.20-7.36) 
MODERATE 
Previous VTE (yes vs no)7,25-27,29-31,36  
 8 Observational Serious† Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 6.08 (95% CI, 3.71-9.97). 
MODERATE 
Thrombophilia (familial or acquired disorder of the hemostatic system; yes vs no)7,25,26,29,34  
 5 Observational Serious† Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 5.88 (95% CI, 2.80-12.35) 
MODERATE 
Malignancy (active malignancy, defined as the presence of cancer on admission or within the past year, vs no active malignancy; and history vs no history of malignancy)7,25-28,30,31,34,36,37  
 10 Observational Serious Not serious Not serious Not serious Undetected ⊕⊕⊕○ Active cancer: OR, 2.65 (95% CI, 1.79-3.91) 
MODERATE History of cancer: OR, 3.20 (95% CI, 2.14-4.79) 
Critical illness: defined as ICU or CCU stay, or need for resuscitation (yes vs no)7,25-27,29,34,36  
 7 Observational Serious† Not serious Not serious Not serious Undetected ⊕⊕⊕○ OR, 1.65 (95% CI, 1.39-1.95) 
MODERATE 
Infections: including cellulitis, pneumonia, and sepsis (yes vs no)28,31  
 5 Observational Serious† Not serious Not serious Not serious Undetected ⊕⊕⊕○ Any infection: OR, 1.48 (95% CI, 1.16-1.89) 
MODERATE Acute infection: OR, 1.59 (95% CI, 1.23-2.06) 
Sepsis: OR, 1.07 (95% CI, 0.70-1.62) 
Heart failure (HF) (acute HF vs no acute HF; history of HF vs no history of HF)28,29,31,35,36  
 5 Observational Serious Not serious Not serious Serious‡ Undetected ⊕⊕○○ Acute heart failure: OR, 0.82 (95% CI, 0.42-1.60) 
LOW History of heart failure: OR, 2.68 (95% CI, 1.11-6.44) 
Autoimmune disease: including rheumatological diseases and inflammatory diseases (yes vs no)27,29,31,35  
 4 Observational Serious† Not serious Serious Not serious Undetected ⊕⊕○○ OR, 2.33 (95% CI, 1.13-4.83) 
LOW 
CVC (presence vs absence)31,34  
 2 Observational Serious Not serious Serious§ Not serious Undetected ⊕⊕○○ OR, 2.05 (95% CI, 0.74-5.65) 
LOW 
Severe stroke: defined as acute ischemic stroke (yes vs no)29,31,32,36  
 4 Observational Serious† Not serious Not serious Serious‡ Undetected ⊕⊕○○ Acute ischemic stroke: OR, 1.79 (95% CI, 0.77-4.18) 
LOW When stroke was assessed in terms of the NIHSS, we found consistent results. 
Tobacco (current use vs no current use; previous use vs no previous use)35  
 1 Observational Serious Not serious Not serious Serious‡ Undetected ⊕⊕○○ Current tobacco use: OR, 1.59 (95% CI, 0.28-9.03) 
LOW Previous tobacco use: OR, 0.97 (0.24-3.92) 
Hormone use: defined as estrogen intake (yes vs no)31  
 1 Observational Serious Not serious Not serious Serious‡ Undetected ⊕⊕○○ OR, 0.80 (95% CI, 0.36-1.78). 
LOW 
Renal failure(yes vs no)36  
 1 Observational Serious || Not serious Not serious Very Serious‡,# Undetected ⊕○○○ OR, 0.76 (95% CI, 0.18-3.18) 
VERY LOW 
Respiratory failure (yes vs no)27,29,31,36  
 4 Observational Serious† Not serious Not serious Serious‡ Undetected ⊕⊕○○ Any respiratory failure: OR, 1.04 (95% 0.69-1.58). 
LOW Acute respiratory failure: OR, 1.18 (95% CI, 0.76-1.84) 
Chronic respiratory failure: OR, 0.58 (95% 0.30-1.10) 
Coronary artery disease (yes vs no)29,31,36,37  
 4 Observational Serious† Not serious Serious§ Not serious Undetected ⊕⊕○○ OR, 1.01 (95% CI, 0.33-3.09) 
LOW 

Question: prognostic factors for medical patients; outcome: VTE; setting: inpatient.

BI, Barthel Index; WBC, white blood cell count.

*

Certainty in evidence was downgraded for risk of bias, given a follow-up time of more than 3 months in the included studies that may cause an overestimation of the magnitude of the association (Zhou et al29 : 6 mo after discharge and Yi 2012: 12 mo after discharge).

†

Certainty in evidence was downgraded for imprecision, given that the confidence interval suggests that there may be no association.

‡

Certainty in evidence was downgraded for risk of bias, given that the results of each prognostic factor in the multivariate analysis were not reported and we therefore had to rely on the unadjusted measures of association. Also, the multivariate analysis included only factors statistically significant in the univariate analysis.

§

Certainty in evidence was downgraded for inconsistency but not imprecision, given that the inconsistency is the likely cause for the imprecision.

||

Certainty in evidence was downgraded for imprecision, given the small number of events (n = 32).

Bembenek et al35  assessed the severity of a stroke experienced by an individual by using the NIHSS, a diagnostic tool; results were consistent with the meta-analysis that severe stroke may result in an increase in risk of any DVT (OR, 2.11; 95% CI,: 0.50-8.90) for NIHSS >7 compared with a NIHSS score <7. Also, severe stroke may result in an increase in risk of any DVT (OR, 1.34; 95% CI,: 0.25-7.18) for NIHSS >14 compared with a NIHSS <14. When NIHSS was assessed continuously, results showed that severe stroke may result in an increase in risk of any DVT (OR, 1.21; 95% CI,: 0.86-1.70) for each additional 4 points on the NIHSS.

#

Fan et al,36  with 458 patients older than 60 y of which 45 patients had any VTE, presented age as a continuous variable and showed no association between age and any VTE (OR, 1.03; 95% CI, 0.98-1.08). Bembenek et al,35  with 299 patients of which 9 had any DVT, 7 of which were distal, presented age per 10-y increase and showed a decrease in risk per 10-y increase in age with any DVT (OR, 0.64; 95% CI, 0.33-1.24).

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