The Treatment Intensity of Anticoagulant Therapy for Patients With Sepsis-Induced Disseminated Intravascular Coagulation and Outcomes: A Multicenter Cohort Study

被引:5
作者
Kudo, Daisuke [1 ]
Hayakawa, Mineji [2 ]
Iijima, Hiroaki [3 ]
Yamakawa, Kazuma [4 ]
Saito, Shinjiro [5 ]
Uchino, Shigehiko [5 ]
Iizuka, Yusuke [6 ]
Sanui, Masamitsu [6 ]
Takimoto, Kohei [7 ,8 ]
Mayumi, Toshihiko [9 ]
Azuhata, Takeo
Ito, Fumihito
Yoshihiro, Shodai
Hayakawa, Katsura
Nakashima, Tsuyoshi
Ogura, Takayuki
Noda, Eiichiro
Nakamura, Yoshihiko
Sekine, Ryosuke
Yoshikawa, Yoshiaki
Sekino, Motohiro
Ueno, Keiko
Okuda, Yuko
Watanabe, Masayuki
Tampo, Akihito
Saito, Nobuyuki
Kitai, Yuya
Takahashi, Hiroki
Kobayashi, Iwao
Kondo, Yutaka
Matsunaga, Wataru
Nachi, Sho
Miike, Toru
Takahashi, Hiroshi
Takauji, Shuhei
Umakoshi, Kensuke
Todaka, Takafumi
Kodaira, Hiroshi
Andoh, Kohkichi
Kasai, Takehiko
Iwashita, Yoshiaki
Arai, Hideaki
Murata, Masato
Yamane, Masahiro
Shiga, Kazuhiro
Hori, Naoto
机构
[1] Tohoku Univ, Grad Sch Med, Div Emergency & Crit Care Med, 1-1 Seiryo Machi Aoba ku, Sendai, Miyagi 9808574, Japan
[2] Hokkaido Univ Hosp, Emergency & Crit Care Ctr, Sapporo, Hokkaido, Japan
[3] Hokkaido Univ Hosp, Clin Res & Med Innovat Ctr, Sapporo, Hokkaido, Japan
[4] Osaka Gen Med Ctr, Div Trauma & Surg Crit Care, Osaka, Japan
[5] Jikei Univ, Sch Med, Intens Care Unit, Dept Anesthesiol, Tokyo, Japan
[6] Jichi Med Univ, Saitama Med Ctr, Dept Anesthesiol & Crit Care Med, Saitama, Japan
[7] Osaka Univ, Grad Sch Med, Dept Anesthesiol & Intens Care Med, Suita, Osaka, Japan
[8] Kameda Med Ctr, Dept Intens Care Med, Kamogawa, Japan
[9] Univ Occupat & Environm Hlth, Dept Emergency Med, Kitakyushu, Japan
关键词
anticoagulant therapy; sepsis; disseminated intravascular coagulation; TRAUMATIC BRAIN-INJURY; SEPTIC SHOCK; INTERNATIONAL GUIDELINES; INSTITUTIONAL VARIATIONS; DIAGNOSTIC-CRITERIA; COMPLICATION RATES; MANAGEMENT; MORTALITY; SURGERY; VOLUME;
D O I
10.1177/1076029619839154
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
We examined the institutional variations in anticoagulation therapy for sepsis-induced disseminated intravascular coagulation (DIC) and their effects on patient outcomes. This post hoc analysis of a cohort study included 3195 patients with severe sepsis across 42 intensive care units. To evaluate differences in the intensity of anticoagulation therapy, the proportion of patients receiving anticoagulation therapy and the total number of patients with sepsis-induced DIC were compared. Predicted in-hospital mortality for each patient was calculated using logistic regression analysis. To evaluate survival outcomes, the actual/mean predicted in-hospital mortality ratio in each institution was calculated. Thirty-eight institutions with 2897 patients were included. Twenty-five institutions treated 60% to 100% (high-intensity institutions), while the rest treated 0% to 50% (low-intensity institutions) of patients with sepsis-induced DIC having anticoagulant therapy. Every 10-unit increase in the intensity of anticoagulant therapy was associated with lower in-hospital mortality (odds ratio: 0.904). A higher number of high-intensity institutions (compared to low-intensity institutions) had lower in-hospital mortality and fewer bleeding events than predicted. In conclusion, institutional variations existed in the use of anticoagulation therapy in patients with sepsis-induced DIC. High-intensity anticoagulation therapy was associated with better outcomes.
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页数:8
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