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Semin Thromb Hemost
DOI: 10.1055/s-0044-1801825
Review Article

Venous Thromboembolism Occurrence and Association with Gastrointestinal Disorders in Children with Cystic Fibrosis: An Analysis from the TriNetX Research Network Global Multicenter Real-World Dataset

Carolena Trocchia
1   Department of Pediatric Gastroenterology, Lucille Packard Children's Hospital of Stanford, Palo Alto, California
,
Dina Ashour
2   Epidemiology/Biostatistics Unit, Johns Hopkins All Children's Hospital and Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, Florida
,
Maua Mosha
3   Department of Pediatric Gastroenterology, University of South Florida Morsani College of Medicine, Tampa, Florida
,
Bailey Hamner
3   Department of Pediatric Gastroenterology, University of South Florida Morsani College of Medicine, Tampa, Florida
4   Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Marisol Betensky
5   Department of Hematology and Oncology, Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
,
Neil Goldenberg
6   Department of Pediatrics and Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
7   Department Research, Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, Florida
,
Racha Khalaf
3   Department of Pediatric Gastroenterology, University of South Florida Morsani College of Medicine, Tampa, Florida
8   Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Florida
› Author Affiliations
Funding This work was supported by an institutional research award from the Johns Hopkins All Children's Foundation. This resource provided funding for statistical support and analysis along with use of the TriNetX database with safe storage of data. This resource did not influence the choice of the type of manuscript or journal chosen for publication. This work was also supported by a Harry Shwachman Cystic Fibrosis Clinical Investigator Award (#005206Q123) and a Cystic Fibrosis Foundation, Research Additional Mentoring Program Award (005583Q123) to Racha Khalaf.
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Abstract

The purpose of this study is to (1) estimate and compare the prevalence of venous thromboembolism (VTE) in children (age 0 to ≤21) with versus without cystic fibrosis (CF); (2) investigate putative associations between specific gastrointestinal (GI) manifestations and the development of VTE among children with CF. This was a multicenter case–control analysis among patients aged 0 to ≤ 21 years between 2010 and 2020, using the TriNetX Research Network. Data queries included ICD-9/10 (International Classification of Diseases-9th/10th Revision) diagnosis codes. Bivariate associations with VTE among CF patients were compared using Chi-square testing for categorical variables and Student's t-test for continuous variables. We used multivariable logistic regression to test for independent associations of GI manifestations with VTE among children with CF, with adjustment for other salient covariates. There was a total of 7,689 children with and 22,327,660 without CF. The frequency of occurrence of VTE was increased nearly 20-fold among those with, as compared with without CF (130 vs. 7 per 10,000 patients). Acute pancreatitis (adjusted odd ratio [aOR] = 3.80, [95% confidence interval, CI: 2.00–7.22]), biliary disease (aOR = 2.17 [95% CI: 1.17–4.03]), gastrostomy status (aOR = 2.01 [95% CI: 1.27–3.18]), and malabsorption/malnutrition (aOR = 2.41 [95% CI: 1.52–3.82]) were each associated with a higher likelihood of VTE among children with CF. In conclusion, we found a significantly increased frequency of VTE occurrence and association of specific GI diseases as independent risk factors for VTE among children with CF compared with those without.

Keywords

cystic fibrosis - gastrointestinal manifestations - venous thromboembolism - medications

Authors' Contributions

Carolena Trocchia: conceptualization, data curation, funding acquisition, investigation, resources, original draft, review, and editing.


Dina Ashour: project administration, software, formal analysis, resources, review, and editing.


Maua Mosha: conceptualization, data acquisition, formal analysis, project administration, software, resources, review, and editing.


Marisol Betensky: investigation, resources, review, and editing.


Neil Goldenberg: conceptualization, data curation, investigation, resources, review and editing, and supervision.


Racha Khalaf: conceptualization, data curation, investigation, funding acquisition, resources, review and editing, and supervision.




Publication History

Article published online:
13 January 2025

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