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BackgroundUpper extremity deep-vein thrombosis (UEDVT) is often under-recognized and perceived as less consequential than lower extremity DVT. This study evaluated the risk factors and outcomes of critically ill patients with UEDVT.MethodsWe evaluated patients in the adult ICUs of a tertiary-care hospital who had Doppler ultrasound for suspected acute upper extremity vein thrombosis between January 2022 and December 2023 and documented the presence of UEDVT and superficial-vein thrombosis (UESVT). We compared patients with and without UEDVT, specifically evaluating the incidence of pulmonary embolism and hospital mortality.ResultsAmong 9605 ICU admissions, 501 patients underwent upper extremity ultrasound at a median of 13 days after hospital admission. These patients had a median age of 66 years and were predominantly male (60.3%). 143 patients (28.5%) had UEDVT and 169 (33.7%) UESVT (54 patients had both). UEDVT was significantly associated with central venous catheters, particularly hemodialysis lines. Pulmonary embolism was more common in patients with UEDVT (19.6% versus 10.3%, p=0.005; adjusted odds ratio, 2.08; 95% confidence interval, 1.16-3.71) with a higher rate in patients with multiple versus one affected vein (32.6% versus 13.4%, p=0.007). Hospital mortality was higher in patients with UEDVT (51.7% versus 31.6%, p<0.0001; adjusted odds ratio, 2.05; 95% confidence interval, 1.22-3.45). UESVT was not associated with pulmonary embolism or mortality.ConclusionsUEDVT is an important complication in critically ill patients and may be associated with an increased risk of pulmonary embolism and mortality, underscoring the importance of prevention, early detection, and appropriate therapeutic approach.