New research suggests that age 70 and older may be the strongest independent predictor of DVT in patients with lower limb cellulitis, surpassing other risks.
A 10-year retrospective study suggests that in patients with lower limb cellulitis, age—more than any biomarker or comorbidity—may be the most significant risk factor for developing deep vein thrombosis.
Researchers reviewed records of 158 patients treated for lower limb cellulitis between 2013 and 2023. Among them, 36 patients underwent venous ultrasound imaging after presenting with elevated D-dimer levels (≥0.5 µg/mL). Deep vein thrombosis (DVT) was diagnosed in 7 of these 36 patients (19.4%).
The study found that patients aged 70 years or older had a significantly higher risk of DVT compared with younger individuals. In multivariate logistic regression analysis, being age 70 or older was associated with an adjusted odds ratio of 13.5 (95% CI, 1.1–165.3; P = .049), making it the only independent predictor of thrombosis. Other variables examined—including C-reactive protein (CRP) levels, body mass index (BMI), diabetes mellitus, malignancy, and corticosteroid use—did not show statistically significant associations with DVT.
The investigators also noted that inflammation and immobility, both of which are common in cellulitis and established contributors to thrombosis, did not correlate with increased clotting risk in this cohort. CRP levels and D-dimer levels were elevated across all participants but did not differ significantly between those with and without DVT.
The study revealed that 57.1% of thrombosis cases occurred in the limb contralateral to the site of cellulitis. Thrombotic events affected various venous locations, including the iliac, peroneal, and soleus veins. The average time between diagnosis of cellulitis and diagnosis of DVT was 17.4 days (range, 5–47 days).
The authors reported that while factors such as obesity and inflammation are traditionally considered risk factors for DVT, their analysis indicated that, in the context of lower limb cellulitis, advanced age may play a more critical role. They suggested that clinicians may need to maintain a high index of suspicion for DVT in older adults, even when other known risk indicators are not present.
Limitations of the study included its retrospective, single-center design, a small sample size, and the use of elevated D-dimer levels as a criterion for ultrasound imaging, which may have resulted in underdiagnosis of deep vein thrombosis. Further studies with larger patient populations are needed to validate these findings and to clarify the biological mechanisms that may link advanced age with venous thromboembolism in the context of cellulitis.
The authors declared no conflicts of interest.
Source: Frontiers