패혈증 유발 파종성 혈관내 응고 환자에서 AntithrombinⅢ 보충의 임상적 효과 분석
Analysis of Clinical Effects of AntithrombinⅢ Supplementation Therapy in Patients with Sepsis-induced Disseminated Intravascular Coagulation
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Background : A recent research study published in Japan showed the clinical effects of ATⅢ supplementation therapy in patients with sepsis-induced disseminated intravascular coagulation (DIC). The study found that in-hospital mortality decreased only in the group with ATⅢ activation of 43% or less (HR: 0.603, P=0.045). Based on that study, it would be needed to verify a domestic application standard, starting a supplementation therapy at 70% or less of ATⅢ activity. Hence, this study conducted a retrospective analysis of clinical effects according to ATⅢ activation and suggested the need for a new application standard. Methods : Data collected from the electronic medical record were divided into two groups based on 43% ATⅢ activation and the data were analyzed for differences in prothrombin time (PT) and platelet improvement, PT and platelet variation, and 28-day mortality. Results : In 76 sepsis-induced DIC patients who were injected with ATⅢ from January 2015 to December 2017, 35 patients (46.05%) had an ATⅢ activation of 43% or less and 41 (53.95%) were over 43 percent. The number of patients who had PT improvement after ATⅢ supplementation therapy was 16 (45.7%) in the 43% or less ATIII group and 12 (29.3%) in the 43% group (P=0.138). Three patients (8.6%) had platelet improvement in the 43% or less group and three (7.3%) had platelet improvement in the 43% ATIII group (P=1.000). The PT variation was -4.94±7.65 and -3.38±4.89 in the 43% or less and 43% ATIII groups, respectively (P=0.286). The platelet variation was 11.47±30.7 and 6.31±31.86 in the 43% or less and 43% ATIII groups, respectively (P=0.478). The 28-day mortality was 48.6% in the 43% or less ATIII group and 41.5% in the 43% group (P=0.534). Conclusions : As a result of comparing patients exceeding 43% ATⅢ activation with those below 43%, the frequency of PT improvement and the mean of PT variation showed that the patients with 43% ATⅢ activation or less had a tendency toward improvement on a numerical basis. Accordingly, large-scale, multi-center studies are needed to generate a new domestic application standard for ATⅢ supplementation therapy.
Abstract
Background : A recent research study published in Japan showed the clinical effects of ATⅢ supplementation therapy in patients with sepsis-induced disseminated intravascular coagulation (DIC). The study found that in-hospital mortality decreased only in the group with ATⅢ activation of 43% or less (HR: 0.603, P=0.045). Based on that study, it would be needed to verify a domestic application standard, starting a supplementation therapy at 70% or less of ATⅢ activity. Hence, this study conducted a retrospective analysis of clinical effects according to ATⅢ activation and suggested the need for a new application standard. Methods : Data collected from the electronic medical record were divided into two groups based on 43% ATⅢ activation and the data were analyzed for differences in prothrombin time (PT) and platelet improvement, PT and platelet variation, and 28-day mortality. Results : In 76 sepsis-induced DIC patients who were injected with ATⅢ from January 2015 to December 2017, 35 patients (46.05%) had an ATⅢ activation of 43% or less and 41 (53.95%) were over 43 percent. The number of patients who had PT improvement after ATⅢ supplementation therapy was 16 (45.7%) in the 43% or less ATIII group and 12 (29.3%) in the 43% group (P=0.138). Three patients (8.6%) had platelet improvement in the 43% or less group and three (7.3%) had platelet improvement in the 43% ATIII group (P=1.000). The PT variation was -4.94±7.65 and -3.38±4.89 in the 43% or less and 43% ATIII groups, respectively (P=0.286). The platelet variation was 11.47±30.7 and 6.31±31.86 in the 43% or less and 43% ATIII groups, respectively (P=0.478). The 28-day mortality was 48.6% in the 43% or less ATIII group and 41.5% in the 43% group (P=0.534). Conclusions : As a result of comparing patients exceeding 43% ATⅢ activation with those below 43%, the frequency of PT improvement and the mean of PT variation showed that the patients with 43% ATⅢ activation or less had a tendency toward improvement on a numerical basis. Accordingly, large-scale, multi-center studies are needed to generate a new domestic application standard for ATⅢ supplementation therapy.
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