PURPOSE: To evaluate the changes in the antithrombin III (antithrombin) values after initial supplementation in order to predict outcome in critically ill patients, we conducted a retrospective study.
METHODS: All consecutive patients admitted to the ICU and treated with antithrombin were enrolled in the study. Initial doses of 1,500 IU or 30 IU/kg antithrombin concentrates were administered over an hour. The clinical backgrounds of the patients were collected from computer-based records. Serial data of antithrombin were collected from the first day of administration (Day 0) to days 1 to 4. The patients were subdivided into two groups based on whether they demonstrated an increased antithrombin activity of more than 60% on the first day after the initial supplementation (responders) or not (non responders).
RESULTS: Four hundred and thirty-five patients were enrolled in the present study. Two hundred and eighty-eight patients could achieve an antithrombin activity of more than 60%. The outcome was significantly different between the two groups. A logistic regression analysis revealed the day 1 antithrombin level and an initial increase of less than 60% after supplementation to be independently associated with ICU mortality. We also found a significant increase in the platelet counts and fibrinogen levels, and a decrease in the DIC scores for the responders.
CONCLUSION: In conclusion, our findings demonstrated the first-day dynamic change in antithrombin activity, and not the basal level, to be able to predict critically ill patient death. This dynamic change was associated with an improvement in the platelet counts, fibrinogen levels, and the DIC score.
CLINICAL IMPLICATIONS: The main value of this retrospective study lies in its patient population and doses of supplemented antithrombin. Population of patients were not restricted to those with sepsis but included all consecutive patients who had been administered antithrombin. The treatment did not aim at achieving a supranormal level of antithrombin activity.
DISCLOSURE: Satoshi Gando, None.