Antithrombin supplementation and mortality in sepsis-induced disseminated intravascular coagulation: A multicenter retrospective observational study

Mineji Hayakawa, Daisuke Kudo, Shinjiro Saito, Shigehiko Uchino, Kazuma Yamakawa, Yusuke Iizuka, Masamitsu Sanui, Kohei Takimoto, Toshihiko Mayumi, Kota Ono, Takeo Azuhata, Fumihito Ito, Shodai Yoshihiro, Katsura Hayakawa, Tsuyoshi Nakashima, Takayuki Ogura, Eiichiro Noda, Yoshihiko Nakamura, Ryosuke Sekine, Yoshiaki YoshikawaMotohiro Sekino, Keiko Ueno, Yuko Okuda, Masayuki Watanabe, Akihito Tampo, Nobuyuki Saito, Yuya Kitai, Hiroki Takahashi, Iwao Kobayashi, Yutaka Kondo, Wataru Matsunaga, Sho Nachi, Toru Miike, Hiroshi Takahashi, Shuhei Takauji, Kensuke Umakoshi, Takafumi Todaka, Hiroshi Kodaira, Kohkichi Andoh, Takehiko Kasai, Yoshiaki Iwashita, Hideaki Arai, Masato Murata, Masahiro Yamane, Kazuhiro Shiga, Naoto Hori

Research output: Contribution to journalArticle

30 Citations (Scopus)

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 ATsupplementation for DIC is insufficient. This multicenter retrospective observational study aimed to clarify the effect of ATsupplementation 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.

Original languageEnglish
Pages (from-to)623-631
Number of pages9
JournalShock
Volume46
Issue number6
DOIs
Publication statusPublished - 2016

Keywords

  • Antithrombin
  • coagulation abnormality
  • disseminated intravascular coagulation
  • mortality
  • sepsis

ASJC Scopus subject areas

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

Fingerprint Dive into the research topics of 'Antithrombin supplementation and mortality in sepsis-induced disseminated intravascular coagulation: A multicenter retrospective observational study'. Together they form a unique fingerprint.

  • Cite this

    Hayakawa, M., Kudo, D., Saito, S., Uchino, S., Yamakawa, K., Iizuka, Y., Sanui, M., Takimoto, K., Mayumi, T., Ono, K., Azuhata, T., Ito, F., Yoshihiro, S., Hayakawa, K., Nakashima, T., Ogura, T., Noda, E., Nakamura, Y., Sekine, R., ... Hori, N. (2016). Antithrombin supplementation and mortality in sepsis-induced disseminated intravascular coagulation: A multicenter retrospective observational study. Shock, 46(6), 623-631. https://doi.org/10.1097/SHK.0000000000000727