Open Access Emergency Medicine (Apr 2022)
The Necessity of Individualized Treatment for Sepsis-Associated Disseminated Intravascular Coagulation by Infected Organ
Abstract
Makoto Kobayashi,1 Yoshimatsu Ehama,2 Suguru Hirayama2 1Intensive Care Center, Hakodate Goryoukaku Hospital, Hakodate City, Hokkaido, Japan; 2Department of Emergency Medicine, Hakodate Goryoukaku Hospital, Hakodate City, Hokkaido, JapanCorrespondence: Makoto Kobayashi, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku-cho, Hakodate City, Hokkaido, 040-8611, Japan, Tel +81-138-51-2295, Fax +81-138-56-2695, Email [email protected]: Several studies have shown that anticoagulation can improve survival outcomes in patients with sepsis-associated disseminated intravascular coagulation (DIC). A guideline from Japan in 2020 suggested two therapeutic agents for sepsis-associated DIC treatment: antithrombin (AT) replacement therapy and recombinant thrombomodulin (rTM) preparation. In 2021, our preliminary study proposed that different organs of septic infection might lead to distinct treatment outcomes following different therapies against DIC. In this study, we created a subanalysis on the influence of AT replacement therapy and rTM preparations on overall survival (OS) by comparing two causative organs: biliary and respiratory tract infections.Patients and Methods: This retrospective cohort study in a single institution involved patients with sepsis-associated DIC treated by either AT or rTM who were categorized based on sources of infection. The two groups defined for this study were biliary (n = 62) and respiratory tract infection (n = 84). To assess the clinical efficacy of AT and rTM, 30-day OS was examined using a stepwise variable selection for a Cox proportional hazards model.Results: The analysis of factors influencing OS by each group showed that rTM preparation remained a significant factor in the biliary tract infection group (HR 0.306, 95% CI 0.133– 0.706). In the respiratory tract infection group, the score of the Acute Physiology and Chronic Health Evaluation II (HR 1.109, 95% CI 1.051– 1.170), polymyxin B hemoperfusion (HR 0.390, 95% CI 0.161– 0.944), and AT replacement therapy (HR 0.510, 95% CI 0.261– 0.997) were established as significant factors.Conclusion: This study revealed that the OS of patients with biliary tract and respiratory tract infections differed depending on the DIC therapeutic agent. Based on these results, we could suggest that it is necessary to develop individualized treatment strategies for septic infections, taking into consideration the differences in the infected organs.Graphal Abstract: Keywords: antithrombin, recombinant thrombomodulin, overall survival, biliary tract infection, respiratory tract infection
