Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Tokyo, Japan.
Department of General and Acute Medicine, Seitokai Azuhata Hospital, Ibaraki, Japan.
Clin Appl Thromb Hemost. 2020 Jan-Dec;26:1076029620912827. doi: 10.1177/1076029620912827.
Supernormal antithrombin (AT) activity is rare in patients with sepsis. This study compared mortality rate of patients with sepsis and supernormal AT activity with that of other patients. This retrospective study included patients with sepsis from 42 intensive care units (ICUs) in Japan. Patients were included if their AT activity was measured on ICU admission, and if they did not receive AT concentrate. They were categorized into low, normal, and supernormal with respective AT activity of ≤70%, >70% to ≤100%, and >100%. The primary outcome was hospital in-patient mortality. Nonlinear regression analysis showed that mortality risk gradually increased with AT activity in the supernormal range, but without statistical significance. Survival rate was significantly lower in low (67%) and supernormal (57%) AT groups than in the normal AT group (79%; < .001 and = .008, respectively). After adjusting for disease severity and AT activity on day 2, supernormal AT activity was the only independent predictor of mortality. Sepsis with supernormal AT activity associated with high mortality, independent of disease severity, might be a predictor of in-hospital mortality.
超正常抗凝血酶 (AT) 活性在脓毒症患者中较为罕见。本研究比较了脓毒症伴超正常 AT 活性患者与其他患者的死亡率。这项回顾性研究纳入了来自日本 42 个重症监护病房 (ICU) 的脓毒症患者。纳入标准为 ICU 入院时测定 AT 活性，且未接受 AT 浓缩物治疗的患者。根据 AT 活性将患者分为低、正常和超正常组，相应的 AT 活性分别为 ≤70%、>70% 至 ≤100% 和 >100%。主要结局为住院病死率。非线性回归分析显示，超正常 AT 活性范围内死亡率风险逐渐增加，但无统计学意义。低 (67%) 和超正常 (57%) AT 组的生存率显著低于正常 AT 组 (79%；<.001 和 =.008，分别)。在校正疾病严重程度和第 2 天 AT 活性后，超正常 AT 活性是死亡率的唯一独立预测因素。脓毒症伴超正常 AT 活性与高死亡率相关，独立于疾病严重程度，可能是住院病死率的预测因素。
