Abstract 4344420: Validation of the Padua Prediction Score in Predicting Venous Thromboembolism Among Patients with Chronic Kidney Disease Admitted to the Intensive Care Unit: A Retrospective Cohort Study

Abstract

Introduction/Background: Chronic kidney disease (CKD) is associated with a prothrombotic state, increasing the risk of venous thromboembolism (VTE) among critically ill patients. Despite thromboprophylaxis, VTE remains a significant complication due to factors such as immobilization and catheter use. The Padua Prediction Score (PPS) is a validated risk stratification tool for medical inpatients, but its utility in critically ill CKD patients has not been adequately assessed. Research Questions/Hypothesis: This study aimed to evaluate the diagnostic accuracy of the PPS in predicting VTE among CKD patients admitted to the ICU. The null hypothesis was that no association exists between high PPS (≥4) and the development of VTE in this population. Methods/Approach: A retrospective cohort study was conducted at the National Kidney and Transplant Institute ICU from January 2019 to May 2024. Adult CKD patients admitted to the ICU who underwent diagnostic testing for VTE were included. Patients with prior anticoagulation or active bleeding were excluded. VTE was diagnosed via lower extremity venous duplex ultrasound and/or chest CT angiography. PPS scores were categorized as low (<4) or high (≥4). Descriptive statistics were used to characterize the population, and sensitivity, specificity, and predictive values were computed to assess PPS performance. Results/Data: Among 219 eligible CKD ICU patients, the cumulative incidence of VTE was 2.3% overall—3.9% in the high-risk PPS group and 1.4% in the low-risk group (Table 1). PPS demonstrated 60.0% sensitivity and 65.0% specificity. The positive predictive value (PPV) was 3.9%, while the negative predictive value (NPV) was 98.6% (Table 2). These findings suggest high reliability in ruling out VTE in low-risk patients but poor discrimination in identifying high-risk individuals. Conclusion: The PPS showed limited accuracy in predicting VTE among ICU-admitted CKD patients, with low sensitivity and PPV, but a high NPV. While PPS may still be useful in identifying low-risk individuals who may not require aggressive surveillance or intervention, its predictive performance in ICU settings warrants caution. Future studies with larger multicenter cohorts and complete diagnostic testing are recommended to refine VTE risk assessment in this population.