Akatsuka Masayuki, Masuda Yoshiki, Tatsumi Hiroomi, Sonoda Tomoko
Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan.
J Intensive Care. 2020 Dec 11;8(1):94. doi: 10.1186/s40560-020-00512-w.
Clinical evidence showing the effectiveness of recombinant human soluble thrombomodulin (rhTM) for treating sepsis-induced disseminated intravascular coagulation (DIC) and organ dysfunction (particularly renal injury) is limited because of differences in the inclusion criteria and disease severity among patients. This study aimed to assess the association between rhTM and outcomes in septic DIC patients with acute kidney injury (AKI).
This retrospective observational study analyzed the data of patients who were admitted to the intensive care unit (ICU) of a single center between January 2012 and December 2018, and diagnosed with sepsis-induced DIC and AKI. Data were extracted as follows: patients' characteristics; DIC score, as calculated by the Japanese Association for Acute Medicine and the International Society of Thrombosis and Hemostasis criteria; serum creatinine levels; and ICU and 28-day mortality rates. The primary outcome was the dependence on renal replacement therapy (RRT) at ICU discharge. The propensity score (PS) was calculated using the following variables: age, sex, septic shock at admission, DIC score, and KDIGO classification. Subsequently, logistic regression analysis was performed using the PS to evaluate the outcome.
In total, 97 patients were included in this study. Of these, 52 (53.6%) patients had received rhTM. The dependence on RRT at ICU discharge was significantly lower in the rhTM than in the non-rhTM group (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.19-0.97; P = 0.043). The serum creatinine levels at ICU discharge (OR, 0.31; 95% CI, 0.13-0.72; P = 0.007) and hospital discharge (OR, 0.25; 95% CI, 0.11-0.60; P = 0.002, respectively), and the 28-day mortality rate (OR, 0.40; 95% CI, 0.17-0.93; P = 0.033) were significantly lower in the rhTM than in the non-rhTM group. Moreover, the Kaplan-Meier survival curve revealed significantly lower mortality rates in the rhTM than in the non-rhTM group (P = 0.009). No significant differences in the DIC score and AKI severity were observed between the groups.
Among sepsis-induced DIC patients with AKI, rhTM administration was associated with lower dependence on RRT at ICU discharge, improvement in renal function, and lower 28-day mortality rate.
由于患者纳入标准和疾病严重程度存在差异，关于重组人可溶性血栓调节蛋白（rhTM）治疗脓毒症诱导的弥散性血管内凝血（DIC）及器官功能障碍（尤其是肾损伤）有效性的临床证据有限。本研究旨在评估rhTM与脓毒症相关性DIC合并急性肾损伤（AKI）患者预后之间的关联。
这项回顾性观察性研究分析了2012年1月至2018年12月期间入住单中心重症监护病房（ICU）、诊断为脓毒症诱导的DIC和AKI患者的数据。数据提取如下：患者特征；根据日本急性医学协会和国际血栓与止血协会标准计算的DIC评分；血清肌酐水平；以及ICU和28天死亡率。主要结局是ICU出院时对肾脏替代治疗（RRT）的依赖情况。使用以下变量计算倾向评分（PS）：年龄、性别、入院时的脓毒症休克、DIC评分和KDIGO分级。随后，使用PS进行逻辑回归分析以评估结局。
本研究共纳入97例患者。其中52例（53.6%）患者接受了rhTM治疗。rhTM组ICU出院时对RRT的依赖程度显著低于未接受rhTM治疗的组（比值比[OR]，0.43；95%置信区间[CI]，0.19 - 0.97；P = 0.043）。rhTM组ICU出院时（OR，0.31；95% CI，0.13 - 0.72；P = 0.007）和出院时（OR，0.25；95% CI，0.11 - 0.60；P = 0.002）的血清肌酐水平以及28天死亡率（OR，0.40；95% CI，0.17 - 0.93；P = 0.033）均显著低于未接受rhTM治疗的组。此外，Kaplan - Meier生存曲线显示rhTM组的死亡率显著低于未接受rhTM治疗的组（P = 0.009）。两组之间的DIC评分和AKI严重程度无显著差异。
在脓毒症诱导的DIC合并AKI患者中，给予rhTM与ICU出院时对RRT的依赖程度降低、肾功能改善以及28天死亡率降低相关。
