The effect of recombinant human soluble thrombomodulin on renal function and mortality in septic disseminated intravascular coagulation patients with acute kidney injury: a retrospective study.
The effect of recombinant human soluble thrombomodulin on renal function and mortality in septic disseminated intravascular coagulation patients with acute kidney injury: a retrospective study.
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DOI：
10.1186/s40560-020-00512-w
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发表时间：
2020-12-11
影响因子：
7.1
通讯作者：
Sonoda T
中科院分区：
文献类型：
--
作者：
Akatsuka M;Masuda Y;Tatsumi H;Sonoda T
由于患者的入选标准和疾病严重程度不同，显示重组人可溶性血栓调节蛋白（rhTM）治疗脓毒症诱导的弥散性血管内凝血（DIC）和器官功能障碍（特别是肾损伤）的有效性的临床证据有限。本研究旨在评估rhTM与脓毒性DIC伴急性肾损伤（阿基）患者结局之间的相关性。本回顾性观察性研究分析了2012年1月至2018年12月期间入住单中心重症监护室（ICU）并诊断为脓毒症诱导的DIC和阿基的患者数据。数据提取如下：患者特征; DIC评分，根据日本急性医学协会和国际血栓与止血学会标准计算;血清肌酐水平; ICU和28天死亡率。主要结局是ICU出院时对肾脏替代治疗（RRT）的依赖性。使用以下变量计算倾向评分（PS）：年龄、性别、入院时感染性休克、DIC评分和KDIGO分类。随后，使用PS进行逻辑回归分析以评价结局。本研究共纳入97例患者。其中，52例（53.6%）患者接受了rhTM治疗。rhTM组在ICU出院时对RRT的依赖性显著低于非rhTM组（比值比[OR]，0.43; 95%置信区间[CI]，0.19-0.97; P = 0.043）。ICU出院时血清肌酐水平（OR，0.31; 95% CI，0.13-0.72; P = 0.007）和出院rhTM组的死亡率（OR，0.25; 95%CI，0.11-0.60; P = 0.002）和28天死亡率（OR，0.40; 95%CI，0.17-0.93; P = 0.033）显著低于非rhTM组。此外，Kaplan-Meier生存曲线显示rhTM组的死亡率显著低于非rhTM组（P = 0.009）。两组间DIC评分和阿基严重程度无显著差异。在脓毒症诱导的DIC伴阿基患者中，rhTM给药与ICU出院时对RRT的依赖性降低、肾功能改善和28天死亡率降低相关。
Clinical evidence showing the effectiveness of recombinant human soluble thrombomodulin (rhTM) for treating sepsis-induced disseminated intravascular coagulation (DIC) and organ dysfunction (particularly renal injury) is limited because of differences in the inclusion criteria and disease severity among patients. This study aimed to assess the association between rhTM and outcomes in septic DIC patients with acute kidney injury (AKI). This retrospective observational study analyzed the data of patients who were admitted to the intensive care unit (ICU) of a single center between January 2012 and December 2018, and diagnosed with sepsis-induced DIC and AKI. Data were extracted as follows: patients’ characteristics; DIC score, as calculated by the Japanese Association for Acute Medicine and the International Society of Thrombosis and Hemostasis criteria; serum creatinine levels; and ICU and 28-day mortality rates. The primary outcome was the dependence on renal replacement therapy (RRT) at ICU discharge. The propensity score (PS) was calculated using the following variables: age, sex, septic shock at admission, DIC score, and KDIGO classification. Subsequently, logistic regression analysis was performed using the PS to evaluate the outcome. In total, 97 patients were included in this study. Of these, 52 (53.6%) patients had received rhTM. The dependence on RRT at ICU discharge was significantly lower in the rhTM than in the non-rhTM group (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.19–0.97; P = 0.043). The serum creatinine levels at ICU discharge (OR, 0.31; 95% CI, 0.13–0.72; P = 0.007) and hospital discharge (OR, 0.25; 95% CI, 0.11–0.60; P = 0.002, respectively), and the 28-day mortality rate (OR, 0.40; 95% CI, 0.17–0.93; P = 0.033) were significantly lower in the rhTM than in the non-rhTM group. Moreover, the Kaplan–Meier survival curve revealed significantly lower mortality rates in the rhTM than in the non-rhTM group (P = 0.009). No significant differences in the DIC score and AKI severity were observed between the groups. Among sepsis-induced DIC patients with AKI, rhTM administration was associated with lower dependence on RRT at ICU discharge, improvement in renal function, and lower 28-day mortality rate.
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影响因子：
7.1
作者：
Ikezoe T
通讯作者：
Ikezoe T
影响因子：
8.8
作者：
Bakhtiari, K;Meijers, JCM;Levi, M
通讯作者：
Levi, M
影响因子：
8.8
作者：
Ostermann, Marlies;Chang, Rene W. S.
通讯作者：
Chang, Rene W. S.
DOI：
10.1186/cc11868
发表时间：
2012-11-16
期刊：
Critical care (London, England)
影响因子：
--
作者：
Sakr Y;Lobo SM;Moreno RP;Gerlach H;Ranieri VM;Michalopoulos A;Vincent JL;SOAP Investigators
通讯作者：
SOAP Investigators
影响因子：
8.8
作者：
Gando, S;Iba, T;Shimazaki, S
通讯作者：
Shimazaki, S