title: The usefulness of antithrombin activity monitoring during antithrombin supplementation in patients with sepsis-associated disseminated intravascular coagulation.
abstract: BACKGROUND
  Recent studies have repeatedly reported the effectiveness of antithrombin (AT) supplementation for sepsis-associated disseminated intravascular coagulation (DIC). In this study, we intended to elucidate the usefulness of monitoring antithrombin activity during antithrombin supplementation.
  
  
  METHODS
  Data of 926 patients with sepsis-associated DIC who had been undergone AT substitution were retrospectively analyzed. All the patients had received 1500IU/day of AT concentrate for three consecutive days. The patients' demographic characteristics, including the age, body weight, baseline DIC score and baseline AT activity, and treatment-related markers such as the change in DIC score and the change in the AT activity with treatment were analyzed in relation to the 28-day mortality.
  
  
  RESULTS
  Logistic regression analysis revealed a significant association of the patients' age, baseline AT activity, Δ AT activity, baseline DIC score and Δ DIC score to the patients' outcomes. The cutoff values of the AT activities for death calculated by the ROC curve analysis were 41.3% for the baseline AT activity, 72.9% for the post-treatment AT activity and 37.0% for Δ AT activity. The area under the ROC curve (AUC) showed discriminative powers for the baseline AT activity, post-treatment AT activity and Δ AT activity of 0.58, 0.69 and 0.66, respectively.
  
  
  CONCLUSIONS
  Monitoring of the AT activity is useful to predict the patients' outcome. Furthermore, the measurement of baseline AT activity may help in determining the appropriate dose for AT supplementation.
authors.affiliation: Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine. Electronic address: toshiiba@cf6.so-net.ne.jp.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Iba
authors.affiliation: Division of Traumatology, Research Institute, National Defense Medical College. Electronic address: ds0711@ndmc.ac.jp.
authors.forename: Daizoh
authors.initials: D
authors.lastname: Saitoh
authors.affiliation: Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine. Electronic address: gando@med.hokudai.ac.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Gando
authors.affiliation: Department of Haematology, Manchester Royal Infirmary. Electronic address: Jecko.thachil@cmft.nhs.uk.
authors.forename: Jecko
authors.initials: J
authors.lastname: Thachil
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000990:Antithrombin III / Q000378:metabolism; D000991:Antithrombins / Q000008:administration & dosage / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects; D001780:Blood Coagulation Tests; D004211:Disseminated Intravascular Coagulation / Q000150:complications* / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications*; D016896:Treatment Outcome
chemical_list: D000991:Antithrombins; D000990:Antithrombin III
keywords: Anticoagulant agents; Antithrombin III; Consumption coagulopathies; Disseminated intravascular coagulation; Sepsis