Document Detail


Recombinant human soluble thrombomodulin improves mortality and respiratory dysfunction in patients with severe sepsis.
MedLine Citation:
PMID:  22673239     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Respiratory dysfunction associated with severe sepsis is a serious condition leading to poor prognosis. Activation of coagulation is a consequence of and contributor to ongoing lung injury in severe sepsis. The purpose of this study was to examine the efficacy of recombinant human soluble thrombomodulin (rhTM), a novel anticoagulant agent, for treating patients with sepsis-induced disseminated intravascular coagulation (DIC) in terms of mortality and respiratory dysfunction.
METHODS: This study comprised 86 consecutive patients with sepsis-induced DIC who required ventilator management. The initial 45 patients were treated without rhTM (control group), and the following 41 patients were given rhTM (0.06 mg/kg/d) for 6 days (rhTM group). Patients were followed up for 90 days after study entry. Sequential Organ Failure Assessment (SOFA) score and lung injury score were recorded until 7 days after entry.
RESULTS: The baseline characteristic of severity of illness was significantly higher in the rhTM group than in the control group. Nevertheless, 90-day mortality rate in the rhTM group was significantly lower than that in the control group (37% vs. 58%, p = 0.038). There was a significant difference in the serial change of SOFA score from baseline to day 7 between the two groups (p = 0.009). Both the respiratory component of the SOFA score and the lung injury score in the rhTM group were significantly lower compared with the control group (p = 0.034 and p < 0.001, respectively).
CONCLUSIONS: rhTM may have a significant beneficial effect on mortality and respiratory dysfunction in patients with sepsis-induced DIC.
LEVEL OF EVIDENCE: III, therapeutic study.
Authors:
Yoshihito Ogawa; Kazuma Yamakawa; Hiroshi Ogura; Takeyuki Kiguchi; Tomoyoshi Mohri; Yasushi Nakamori; Yasuyuki Kuwagata; Takeshi Shimazu; Toshimitsu Hamasaki; Satoshi Fujimi
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The journal of trauma and acute care surgery     Volume:  72     ISSN:  2163-0763     ISO Abbreviation:  J Trauma Acute Care Surg     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-06-07     Completed Date:  2012-08-21     Revised Date:  2013-09-25    
Medline Journal Info:
Nlm Unique ID:  101570622     Medline TA:  J Trauma Acute Care Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1150-7     Citation Subset:  AIM; IM    
Affiliation:
Department of Emergency and Critical Care, Osaka General Medical Center, Osaka, Japan. yoshi.ogawa@hp-emerg.med.osaka-u.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Aged
Disseminated Intravascular Coagulation / complications,  drug therapy,  mortality*
Dose-Response Relationship, Drug
Female
Follow-Up Studies
Humans
Incidence
Japan / epidemiology
Male
Middle Aged
Prognosis
Recombinant Proteins
Respiratory Insufficiency / drug therapy*,  epidemiology,  etiology
Retrospective Studies
Sepsis / complications,  drug therapy,  mortality*
Survival Rate / trends
Thrombomodulin / administration & dosage,  therapeutic use*
Chemical
Reg. No./Substance:
0/Recombinant Proteins; 0/Thrombomodulin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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