Recombinant human soluble thrombomodulin in sepsis-induced disseminated intravascular coagulation: a multicenter propensity score analysis.
Recombinant human soluble thrombomodulin in sepsis-induced disseminated intravascular coagulation: a multicenter propensity score analysis.
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DOI：
10.1007/s00134-013-2822-2
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发表时间：
2013-04
影响因子：
38.9
通讯作者：
Shimazu, Takeshi
中科院分区：
文献类型：
--
作者：
Yamakawa, Kazuma;Ogura, Hiroshi;Fujimi, Satoshi;Morikawa, Miki;Ogawa, Yoshihito;Mohri, Tomoyoshi;Nakamori, Yasushi;Inoue, Yoshiaki;Kuwagata, Yasuyuki;Tanaka, Hiroshi;Hamasaki, Toshimitsu;Shimazu, Takeshi
重组人血栓调节蛋白（rhTM）用于治疗脓毒症诱发的弥散性血管内凝血（DIC）的疗效、安全性，尤其是与死亡率相关的证据有限。我们假设，与病情严重程度相似但未接受治疗的患者相比，接受rhTM治疗的脓毒症诱发DIC患者死亡率会有所改善。
这项回顾性队列研究于2006年1月至2011年6月在日本三家三级转诊医院开展，纳入了所有因脓毒症诱发DIC且需呼吸机辅助治疗的患者。主要终点为住院死亡率，次要终点包括重症监护病房（ICU）治疗时长、DIC评分变化以及出血并发症发生率。采用回归技术建立倾向模型，以校正组间基线不平衡情况。
符合条件的脓毒症诱发DIC患者共162例，其中68例接受了rhTM治疗，94例未接受。根据基线特征，接受rhTM治疗的患者病情更为严重。经分层倾向评分分析校正这些不平衡因素后，发现rhTM治疗与住院死亡率降低显著相关（校正风险比为0.45；95%置信区间为0.26 - 0.77；p = 0.013）。同时观察到，rhTM治疗与更多的无ICU治疗天数、无呼吸机使用天数和无血管升压药使用天数相关。与对照组相比，rhTM组在接受治疗后的早期，DIC评分显著降低，而两组出血相关不良事件的发生率并无差异。
对于需机械通气的成年脓毒症诱发DIC患者，rhTM治疗可能与住院死亡率降低相关。
Evidence of efficacy and safety of, and especially mortality related to, recombinant human thrombomodulin (rhTM) treatment for sepsis-induced disseminated intravascular coagulation (DIC) is limited. We hypothesized that patients with sepsis-induced DIC receiving treatment with rhTM would have improved mortality compared with those with similar acuity who did not. This retrospective cohort study conducted in three tertiary referral hospitals in Japan between January 2006 and June 2011 included all patients with sepsis-induced DIC who required ventilator management. Primary endpoint was in-hospital mortality, with duration of intensive care unit treatment, changes in DIC scores and rate of bleeding complications as secondary endpoints. Regression technique was used to develop a propensity model adjusted for baseline imbalances between groups. Eligible were 162 patients with sepsis-induced DIC; 68 patients received rhTM and 94 did not. Patients receiving rhTM had higher severity of illness according to baseline characteristics. After adjusting for these imbalances by stratified propensity score analysis, treatment with rhTM was significantly associated with reduced in-hospital mortality (adjusted hazard ratio, 0.45; 95 % confidential interval, 0.26–0.77; p = 0.013). An association between rhTM treatment and higher numbers of intensive care unit-free days, ventilator-free days, and vasopressor-free days were observed. DIC scores were significantly decreased in the rhTM group compared with the control group in the early period after rhTM treatment, whereas the incidence of bleeding-related adverse events did not differ between the two groups. Therapy with rhTM may be associated with reduced in-hospital mortality in adult mechanically ventilated patients with sepsis-induced DIC.
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DOI：
10.1186/cc10228
发表时间：
2011
期刊：
Critical care (London, England)
影响因子：
--
作者：
Yamakawa K;Fujimi S;Mohri T;Matsuda H;Nakamori Y;Hirose T;Tasaki O;Ogura H;Kuwagata Y;Hamasaki T;Shimazu T
通讯作者：
Shimazu T
影响因子：
158.5
作者：
Ranieri, V. Marco;Thompson, B. Taylor;Williams, Mark D.
通讯作者：
Williams, Mark D.
影响因子：
15.1
作者：
Iba, Toshiaki;Nakarai, Etsuro;Ohno, Yoichi
通讯作者：
Ohno, Yoichi
影响因子：
8.8
作者：
Gando, S;Iba, T;Shimazaki, S
通讯作者：
Shimazaki, S
影响因子：
8.8
作者：
Nagato, Masaru;Okamoto, Kohji;Yamaguchi, Koji
通讯作者：
Yamaguchi, Koji