Antithrombin and mortality in severe pneumonia patients with sepsis‐associated disseminated intravascular coagulation: an observational nationwide study. (16th July 2014) - Tagami, T.
Summary Background The association between antithrombin use and mortality in patients with sepsis‐associated disseminated intravascular coagulation (DIC) remains controversial. Objectives To examine the hypothesis that antithrombin could be effective in the treatment of patients with sepsis‐associated DIC following severe pneumonia. Methods Propensity score and instrumental variable analyses were performed by use of a nationwide administrative database, the Japanese Diagnosis Procedure Combination inpatient database. The main outcome was 28‐day mortality. Results Severe pneumonia patients diagnosed with sepsis‐associated DIC (n = 9075) were categorized into antithrombin (n = 2663) and control (n = 6412) groups. Propensity score matching created a matched cohort of 2194 pairs of patients with and without antithrombin use. Mortality differences were found between the two groups (antithrombin vs. control: unmatched, 40.8% vs. 45.7%; propensity‐matched, 40.6% vs. 44.2%; inverse probability‐weighted, 41.1% vs. 45.1%). Multiple logistic regression analyses showed an association between antithrombin use and 28‐day mortality (unmatched with propensity score adjusted, adjusted odds ratio [OR] 0.87, 95% confidence interval [CI] 0.78–0.97; propensity‐matched, adjusted OR 0.85, 95% CI 0.75–0.97; inverse probability‐weighted, adjusted OR 0.85, 95% CI 0.79–0.90). An analysis with the hospital antithrombin‐prescribing rate as an instrumental variable showed that receipt of antithrombin was associated with a 9.9% (95% CI 3.5–16.3) reduction in 28‐day mortality. Conclusions This retrospective, large, nationwide database study demonstrates that antithrombin administration may be associated with reduced 28‐day mortality in patients with severe pneumonia and sepsis‐associated DIC. A large, multinational randomized trial is required.