Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
Emergency and Critical Care Center, Hokkaido University Hospital, 5 Kita8jonishi, Kita-ku, Sapporo 060-0808, Japan.
Thromb Res. 2018 Mar;163:22-29. doi: 10.1016/j.thromres.2017.12.022. Epub 2018 Jan 3.
Anticoagulant therapy for patients with sepsis is not recommended in the latest Surviving Sepsis Campaign guidelines, and non-anticoagulant therapy is the global standard treatment approach at present. We aimed at elucidating the effect of non-anticoagulant therapy on patients with sepsis-induced disseminated intravascular coagulation (DIC), as evidence on this topic has remained inconclusive.
Data from 3195 consecutive adult patients admitted to 42 intensive care units for the treatment of severe sepsis were retrospectively analyzed via propensity score analyses with and without multiple imputation. The primary outcome was in-hospital all-cause mortality.
Among 1784 patients with sepsis-induced DIC, 745 (41.8%) were not treated with anticoagulants. The inverse probability of treatment-weighted (with and without multiple imputation) and quintile-stratified propensity score analyses (without multiple imputation) indicated a significant association between non-anticoagulant therapy and higher in-hospital all-cause mortality (odds ratio [95% confidence interval]: 1.59 [1.19-2.12], 1.32 [1.02-1.81], and 1.32 [1.03-1.69], respectively). However, quintile-stratified propensity score analyses with multiple imputation and propensity score matching analysis with and without multiple imputation did not show this association. Survival duration was not significantly different between patients in the propensity score-matched non-anticoagulant therapy group and those in the anticoagulant therapy group (Cox regression analysis with and without multiple imputation: hazard ratio [95% confidence interval]: 1.26 [1.00-1.60] and 1.22 [0.93-1.59], respectively).
It remains controversial if non-anticoagulant therapy is harmful, equivalent, or beneficial compared with anticoagulant therapy in the treatment of patients with sepsis-induced DIC.
最新的《拯救脓毒症运动指南》不建议对脓毒症患者进行抗凝治疗，而非抗凝治疗是目前全球的标准治疗方法。我们旨在阐明非抗凝治疗对脓毒症诱导的弥散性血管内凝血（DIC）患者的影响，因为关于这一主题的证据尚无定论。
通过倾向评分分析（有无多重插补）对 3195 例连续入住 42 个重症监护病房治疗严重脓毒症的成年患者的数据进行了回顾性分析。主要结局为院内全因死亡率。
在 1784 例脓毒症诱导的 DIC 患者中，745 例（41.8%）未接受抗凝治疗。逆概率治疗加权（有无多重插补）和五分位分层倾向评分分析（无多重插补）表明，非抗凝治疗与较高的院内全因死亡率之间存在显著关联（比值比[95%置信区间]：1.59[1.19-2.12]，1.32[1.02-1.81]和 1.32[1.03-1.69]）。然而，五分位分层倾向评分分析（有多重插补）和倾向评分匹配分析（有无多重插补）均未显示这种关联。在有无多重插补的倾向评分匹配非抗凝治疗组和抗凝治疗组的患者之间，生存时间无显著差异（Cox 回归分析：风险比[95%置信区间]：1.26[1.00-1.60]和 1.22[0.93-1.59]）。
与抗凝治疗相比，非抗凝治疗在治疗脓毒症诱导的 DIC 患者中是否有害、等效或有益仍存在争议。
