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Báo cáo y học: " Treatment effects of recombinant human soluble thrombomodulin in patients with severe sepsis: a historical control study"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Treatment effects of recombinant human soluble thrombomodulin in patients with severe sepsis: a historical control study. | Yamakawa et al. Critical Care 2011 15 R123 http ccforum.eom content 15 3 R123 KS CRITICAL CARE RESEARCH Open Access Treatment effects of recombinant human soluble thrombomodulin in patients with severe sepsis a historical control study 1.2 1 11 12 Kazuma Yamakawa Satoshi Fujimi Tomoyoshi Mohri Hiroki Matsuda Yasushi Nakamori Tomoya Hirose 2 2 2 3 2 Osamu Tasaki Hiroshi Ogura Yasuyuki Kuwagata Toshimitsu Hamasaki and Takeshi Shimazu Abstract Introduction Cross-talk between the coagulation system and inflammatory reactions during sepsis causes organ damage followed by multiple organ dysfunction syndrome or even death. Therefore anticoagulant therapies have been expected to be beneficial in the treatment of severe sepsis. Recombinant human soluble thrombomodulin rhTM binds to thrombin to inactivate coagulation and the thrombin-rhTM complex activates protein C to produce activated protein C. The purpose of this study was to examine the efficacy of rhTM for treating patients with sepsis-induced disseminated intravascular coagulation DIC . Methods This study comprised 65 patients with sepsis-induced DIC who required ventilatory management. All patients fulfilled the criteria of severe sepsis and the International Society on Thrombosis and Haemostasis criteria for overt DIC. The initial 45 patients were treated without rhTM control group and the following 20 consecutive patients were treated with rhTM 0.06 mg kg day for six days rhTM group . The primary outcome measure was 28-day mortality. Stepwise multivariate Cox regression analysis was used to assess which independent variables were associated with mortality. Comparisons of Sequential Organ Failure Assessment SOFA score on sequential days between the two groups were analyzed by repeated measures analysis of variance. Results Cox regression analysis showed 28-day mortality to be significantly lower in the rhTM group than in the control group adjusted hazard ratio 0.303 95 confidence interval 0.106 to 0.871 P 0.027 . .