Abstract
Objectives: In this retrospective study, we examined the clinical course of severe sepsis in patients with DIC who received recombinant human thrombomodulin (rTM) therapy, and compared the differences between survivors and non-survivors. Methods: The study cohort included 17 patients diagnosed with severe sepsis and DIC score between September 1, 2013 and May 31, 2014, in whom rTM therapy was initiated. Evaluation of DIC was completed using the DIC diagnostic criteria of the Japanese Association for Acute Medicine. We examined characteristics of the patients including SOFA score at admission; the time interval between diagnosis of DIC and initiation of rTM therapy; and the changes in DIC score at 1, 3, and 7 days after initiation of rTM therapy, and compared the differences in these parameters between survivors and non-survivors. Results: There were no significant differences regarding the severity of illness between survivors (n=13) and non-survivors (n=4) at intensive care unit admission (SOFA score: 11.1±3.3 vs. 10.8±3.0; mean±SD). The time interval between diagnosis of DIC and initiation of rTM therapy was significantly longer in non-survivors, compared with that for survivors (3 [0-4] vs. 0 [0-1] days; median [range] days). In survivors, the DIC score significantly improved 7 days after initiation of rTM therapy, compared to their score on the first day (1 [1-4] vs. 5 [5-6]; median [range] ). In contrast, in non-survivors, this value did not change significantly (6 [5-7] vs. 8 [7.25-8], median [range] ) by day 7. Conclusion: These results suggest that the prognosis of patients with DIC and severe sepsis will improve with the early initiation of rTM therapy, and an improved DIC score will be observed by 7 days after initiation of therapy.
