Toshiaki Iba1, Daizoh Saitoh2, Satoshi Gando3, Jecko Thachil4. 1. Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine. Electronic address: toshiiba@cf6.so-net.ne.jp. 2. Division of Traumatology, Research Institute, National Defense Medical College. Electronic address: ds0711@ndmc.ac.jp. 3. Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine. Electronic address: gando@med.hokudai.ac.jp. 4. Department of Haematology, Manchester Royal Infirmary. Electronic address: Jecko.thachil@cmft.nhs.uk.
Abstract
INTRODUCTION: Recent studies have repeatedly reported the effectiveness of antithrombin (AT) supplementation for sepsis-associated disseminated intravascular coagulation (DIC). In this study, we intended to elucidate the usefulness of monitoring antithrombin activity during antithrombin supplementation. METHODS: Data of 926 patients with sepsis-associated DIC who had been undergone AT substitution were retrospectively analyzed. All the patients had received 1500IU/day of AT concentrate for three consecutive days. The patients' demographic characteristics, including the age, body weight, baseline DIC score and baseline AT activity, and treatment-related markers such as the change in DIC score and the change in the AT activity with treatment were analyzed in relation to the 28-day mortality. RESULTS: Logistic regression analysis revealed a significant association of the patients' age, baseline AT activity, Δ AT activity, baseline DIC score and Δ DIC score to the patients' outcomes. The cutoff values of the AT activities for death calculated by the ROC curve analysis were 41.3% for the baseline AT activity, 72.9% for the post-treatment AT activity and 37.0% for Δ AT activity. The area under the ROC curve (AUC) showed discriminative powers for the baseline AT activity, post-treatment AT activity and Δ AT activity of 0.58, 0.69 and 0.66, respectively. CONCLUSIONS: Monitoring of the AT activity is useful to predict the patients' outcome. Furthermore, the measurement of baseline AT activity may help in determining the appropriate dose for AT supplementation.
INTRODUCTION: Recent studies have repeatedly reported the effectiveness of antithrombin (AT) supplementation for sepsis-associated disseminated intravascular coagulation (DIC). In this study, we intended to elucidate the usefulness of monitoring antithrombin activity during antithrombin supplementation. METHODS: Data of 926 patients with sepsis-associated DIC who had been undergone AT substitution were retrospectively analyzed. All the patients had received 1500IU/day of AT concentrate for three consecutive days. The patients' demographic characteristics, including the age, body weight, baseline DIC score and baseline AT activity, and treatment-related markers such as the change in DIC score and the change in the AT activity with treatment were analyzed in relation to the 28-day mortality. RESULTS: Logistic regression analysis revealed a significant association of the patients' age, baseline AT activity, Δ AT activity, baseline DIC score and Δ DIC score to the patients' outcomes. The cutoff values of the AT activities for death calculated by the ROC curve analysis were 41.3% for the baseline AT activity, 72.9% for the post-treatment AT activity and 37.0% for Δ AT activity. The area under the ROC curve (AUC) showed discriminative powers for the baseline AT activity, post-treatment AT activity and Δ AT activity of 0.58, 0.69 and 0.66, respectively. CONCLUSIONS: Monitoring of the AT activity is useful to predict the patients' outcome. Furthermore, the measurement of baseline AT activity may help in determining the appropriate dose for AT supplementation.