Ebina Masatomo, Fujino Kazunori, Inoue Akira, Ariyoshi Koichi, Eguchi Yutaka
Department of Emergency Medicine and Intensive Care, Shiga University of Medical Science, Otsu, Japan.
Department of Emergency Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
Clin Med Insights Blood Disord. 2019 Jun 21;12:1179545X19858361. doi: 10.1177/1179545X19858361. eCollection 2019.
Severe sepsis is commonly associated with mortality among critically ill patients and is known to cause coagulopathy. While antithrombin is an anticoagulant used in this setting, serum albumin levels are known to influence serum antithrombin levels. Therefore, this study aimed to evaluate the outcomes of antithrombin supplementation in patients with sepsis-associated coagulopathy, as well as the relationship between serum albumin levels and the effects of antithrombin supplementation.
This retrospective study evaluated patients who were >18 years of age and had been admitted to either of two intensive care units for sepsis-associated coagulopathy. The groups that did and did not receive antithrombin supplementation were compared for outcomes up to 1 year after admission. Subgroup analyses were performed for patients with serum albumin levels of <2.5 g/dL or ⩾2.5 g/dL.
Fifty-one patients received antithrombin supplementation and 163 patients did not. The Cox proportional hazards model revealed that antithrombin supplementation was independently associated with 28-day survival (hazard ratio [HR]: 0.374, = 0.025) but not with 1 year survival (HR: 0.915, = 0.752). In addition, among patients with serum albumin levels of <2.5 g/dL, antithrombin supplementation was associated with a significantly lower 28-day mortality rate (9.4% vs 36.8%, = .009).
Antithrombin supplementation may improve short-term survival, but not long-term survival, among patients with sepsis-associated coagulopathy.
严重脓毒症通常与危重症患者的死亡率相关，并且已知会导致凝血病。虽然抗凝血酶是在这种情况下使用的一种抗凝剂，但已知血清白蛋白水平会影响血清抗凝血酶水平。因此，本研究旨在评估抗凝血酶补充治疗脓毒症相关性凝血病患者的疗效，以及血清白蛋白水平与抗凝血酶补充治疗效果之间的关系。
这项回顾性研究评估了年龄大于18岁且因脓毒症相关性凝血病入住两个重症监护病房之一的患者。比较了接受和未接受抗凝血酶补充治疗的两组患者入院后长达1年的预后情况。对血清白蛋白水平<2.5 g/dL或⩾2.5 g/dL的患者进行亚组分析。
51例患者接受了抗凝血酶补充治疗，163例患者未接受。Cox比例风险模型显示，抗凝血酶补充治疗与28天生存率独立相关（风险比[HR]：0.374，P = 0.025），但与1年生存率无关（HR：0.915，P = 0.752）。此外，在血清白蛋白水平<2.5 g/dL的患者中，抗凝血酶补充治疗与显著较低的28天死亡率相关（9.4%对36.8%，P =.009）。
抗凝血酶补充治疗可能改善脓毒症相关性凝血病患者的短期生存率，但不能改善长期生存率。
