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Shock. 2016 Dec;46(6):623-631.

Antithrombin Supplementation and Mortality in Sepsis-Induced Disseminated Intravascular Coagulation: A Multicenter Retrospective Observational Study.

Author information

1
*Emergency and Critical Care Center, Hokkaido University Hospital, Sapporo, Japan †Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan ‡Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Tokyo, Japan §Department of Emergency Medicine, Osaka General Medical Center, Osaka, Japan ||Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan ¶Department of Critical Care, Shonan Kamakura General Hospital, Kamakura, Japan #Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan **Department of Emergency Medicine, University of Occupational and Environmental Health, Kita-Kyushu, Japan ††Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan ‡‡Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Tokyo, Japan §§Department of Emergency and Critical Care Medicine, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, Koriyama, Japan ||||Pharmaceutical Department, JA Hiroshima General Hospital, Hiroshima, Japan ¶¶Department of Emergency and Critical Care Medicine, Saitama Red Cross Hospital, Saitama, Japan ##Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama, Japan ***Department of Emergency Medicine and Critical Care Medicine, Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan †††Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan ‡‡‡Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Fukuoka, Japan §§§Emergency Department, Ibaraki Prefectural Central Hospital, Kasama, Japan ||||||Division of Intensive Care, Nagasaki University Hospital, Nagasaki, Japan ¶¶¶Department of Emergency and Critical Care Medicine, Tokyo Medical University, Hachioji Medical Center, Tokyo, Japan ###Anesthesiology, Kyoto First Red-Cross Hospital, Kyoto, Japan ****Intensive Care Unit, Saiseikai Yokohamasi Tobu Hospital, Yokohama, Japan ††††Department of Emergency Medicine, Asahikawa Medical University, Asahikawa, Japan ‡‡‡‡Shock and Trauma Center, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan §§§§Emergency Medicine, Kameda Medical Center, Kamogawa, Japan ||||||||Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan ¶¶¶¶Emergency and Critical Care Medicine, Asahikawa Red Cross Hospital, Asahikawa, Japan ####Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan *****Advanced Critical Care Center, Gifu University Hospital, Gifu, Japan †††††Emergency and Critical Care Center, Saga University Hospital, Saga, Japan ‡‡‡‡‡The Division of Cardiovascular Disease, Steel Memorial Muroran Hospital, Muroran, Japan §§§§§Department of Emergency Medicine and Critical Care, Sapporo City General Hospital, Sapporo, Japan ||||||||||Division of Emergency Medicine, Ehime University Hospital, Matsuyama, Japan ¶¶¶¶¶Intensive Care Unit, Tomishiro Central Hospital, Tomishiro, Japan #####Department of Emergency Medicine, Akashi City Hospital, Akashi, Japan ******Critical Care Department, Sendai City Hospital, Sendai, Japan ††††††Emergency Department, Hakodate Municipal Hospital, Hakodate, Japan ‡‡‡‡‡‡Emergency and Critical Care Center, Mie University Hospital, Tsu, Japan §§§§§§Department of Emergency Medicine, Gunma University, Maebashi, Japan ||||||||||||Department of Anesthesia and Intensive Care, KKR Sapporo Medical Center, Sapporo, Japan ¶¶¶¶¶¶Emergency and Critical Care Center, Seirei Mikatahara General Hospital, Hamamatsu, Japan ######Intensive Care Unit, Hyogo College of Medicine, Nishinomiya, Japan.

Abstract

Supplemental doses of antithrombin (AT) are widely used to treat sepsis-induced disseminated intravascular coagulation (DIC) in Japan. However, evidence on the benefits of AT supplementation for DIC is insufficient. This multicenter retrospective observational study aimed to clarify the effect of AT supplementation on sepsis-induced DIC using propensity score analyses. Data from 3,195 consecutive adult patients admitted to 42 intensive care units for severe sepsis treatment were retrospectively analyzed; 1,784 patients were diagnosed with DIC (n = 715, AT group; n = 1,069, control group). Inverse probability of treatment-weighted propensity score analysis indicated a statistically significant association between AT supplementation and lower in-hospital all-cause mortality (n = 1,784, odds ratio [95% confidence intervals]: 0.748 [0.572-0.978], P = 0.034). However, quintile-stratified propensity score analysis (n = 1,784, odds ratio: 0.823 [0.646-1.050], P = 0.117) and propensity score matching analysis (461 matching pairs, odds ratio: 0.855 [0.649-1.125], P = 0.263) did not show this association. In the early days after intensive care unit admission, the survival rate was statistically higher in the propensity score-matched AT group than in the propensity score-matched control group (P = 0.007). In DIC patients without concomitant heparin administration, similar results were observed. In conclusion, AT supplementation may be associated with reduced in-hospital all-cause mortality in patients with sepsis-induced DIC. However, the statistical robustness of this connection was not strong. In addition, although the number of transfusions needed in patients with AT supplementation increased, severe bleeding complications did not.

PMID:
27548460
DOI:
10.1097/SHK.0000000000000727
[Indexed for MEDLINE]

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