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Antithrombin use and 28-day in-hospital mortality among severe-burn patients: an observational nationwide study

BACKGROUND: Previous studies have suggested that antithrombin may be beneficial for treating coagulopathy in patients with severe burns. However, robust evidence for this idea is lacking. We examined the hypothesis that antithrombin may be effective in treating patients with severe burns. METHODS: W...

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Autores principales: Tagami, Takashi, Matsui, Hiroki, Moroe, Yuuta, Fukuda, Reo, Shibata, Ami, Tanaka, Chie, Unemoto, Kyoko, Fushimi, Kiyohide, Yasunaga, Hideo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Paris 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5318343/
https://www.ncbi.nlm.nih.gov/pubmed/28220452
http://dx.doi.org/10.1186/s13613-017-0244-y
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author Tagami, Takashi
Matsui, Hiroki
Moroe, Yuuta
Fukuda, Reo
Shibata, Ami
Tanaka, Chie
Unemoto, Kyoko
Fushimi, Kiyohide
Yasunaga, Hideo
author_facet Tagami, Takashi
Matsui, Hiroki
Moroe, Yuuta
Fukuda, Reo
Shibata, Ami
Tanaka, Chie
Unemoto, Kyoko
Fushimi, Kiyohide
Yasunaga, Hideo
author_sort Tagami, Takashi
collection PubMed
description BACKGROUND: Previous studies have suggested that antithrombin may be beneficial for treating coagulopathy in patients with severe burns. However, robust evidence for this idea is lacking. We examined the hypothesis that antithrombin may be effective in treating patients with severe burns. METHODS: We performed propensity score-matched analyses of the nationwide administrative Japanese Diagnosis Procedure Combination inpatient database. We identified patients with severe burns (burn index ≥ 10) who were recorded in the database from 1 July 2010 to 31 March 2013. We compared patients who were administered antithrombin within 2 days of admission (antithrombin group) and those who were not administered antithrombin (control group). The main outcomes were 28-day mortality and ventilator-free days (VFDs). RESULTS: Eligible patients (n = 3223) from 618 hospitals were categorized into either an antithrombin group (n = 152) or control group (n = 3071). Propensity score matching created a matched cohort of 103 pairs with and without antithrombin. Twenty-eight-day mortality was lower in the antithrombin group compared with the control group in propensity-matched analysis (control vs. antithrombin, 47.6 vs. 33.0%; difference, 14.6%; 95% confidence interval [CI] 1.2–28.0). Cox regression analysis showed a significant difference in 28-day in-hospital mortality between the control and antithrombin propensity-matched groups (hazard ratio 0.58; 95% CI 0.37–0.90). There were significantly more VFDs in the antithrombin compared with the control group in propensity score-matched analysis (control vs. antithrombin, 12.6 vs. 16.4 days; difference −3.7; 95% CI −7.2 to −0.12). CONCLUSIONS: This nationwide database study demonstrated that antithrombin use may improve 28-day survival and increase VFDs in patients with severe burns. Further prospective studies are required to confirm these results. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13613-017-0244-y) contains supplementary material, which is available to authorized users.
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spelling pubmed-53183432017-03-07 Antithrombin use and 28-day in-hospital mortality among severe-burn patients: an observational nationwide study Tagami, Takashi Matsui, Hiroki Moroe, Yuuta Fukuda, Reo Shibata, Ami Tanaka, Chie Unemoto, Kyoko Fushimi, Kiyohide Yasunaga, Hideo Ann Intensive Care Research BACKGROUND: Previous studies have suggested that antithrombin may be beneficial for treating coagulopathy in patients with severe burns. However, robust evidence for this idea is lacking. We examined the hypothesis that antithrombin may be effective in treating patients with severe burns. METHODS: We performed propensity score-matched analyses of the nationwide administrative Japanese Diagnosis Procedure Combination inpatient database. We identified patients with severe burns (burn index ≥ 10) who were recorded in the database from 1 July 2010 to 31 March 2013. We compared patients who were administered antithrombin within 2 days of admission (antithrombin group) and those who were not administered antithrombin (control group). The main outcomes were 28-day mortality and ventilator-free days (VFDs). RESULTS: Eligible patients (n = 3223) from 618 hospitals were categorized into either an antithrombin group (n = 152) or control group (n = 3071). Propensity score matching created a matched cohort of 103 pairs with and without antithrombin. Twenty-eight-day mortality was lower in the antithrombin group compared with the control group in propensity-matched analysis (control vs. antithrombin, 47.6 vs. 33.0%; difference, 14.6%; 95% confidence interval [CI] 1.2–28.0). Cox regression analysis showed a significant difference in 28-day in-hospital mortality between the control and antithrombin propensity-matched groups (hazard ratio 0.58; 95% CI 0.37–0.90). There were significantly more VFDs in the antithrombin compared with the control group in propensity score-matched analysis (control vs. antithrombin, 12.6 vs. 16.4 days; difference −3.7; 95% CI −7.2 to −0.12). CONCLUSIONS: This nationwide database study demonstrated that antithrombin use may improve 28-day survival and increase VFDs in patients with severe burns. Further prospective studies are required to confirm these results. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13613-017-0244-y) contains supplementary material, which is available to authorized users. Springer Paris 2017-02-20 /pmc/articles/PMC5318343/ /pubmed/28220452 http://dx.doi.org/10.1186/s13613-017-0244-y Text en © The Author(s) 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Research
Tagami, Takashi
Matsui, Hiroki
Moroe, Yuuta
Fukuda, Reo
Shibata, Ami
Tanaka, Chie
Unemoto, Kyoko
Fushimi, Kiyohide
Yasunaga, Hideo
Antithrombin use and 28-day in-hospital mortality among severe-burn patients: an observational nationwide study
title Antithrombin use and 28-day in-hospital mortality among severe-burn patients: an observational nationwide study
title_full Antithrombin use and 28-day in-hospital mortality among severe-burn patients: an observational nationwide study
title_fullStr Antithrombin use and 28-day in-hospital mortality among severe-burn patients: an observational nationwide study
title_full_unstemmed Antithrombin use and 28-day in-hospital mortality among severe-burn patients: an observational nationwide study
title_short Antithrombin use and 28-day in-hospital mortality among severe-burn patients: an observational nationwide study
title_sort antithrombin use and 28-day in-hospital mortality among severe-burn patients: an observational nationwide study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5318343/
https://www.ncbi.nlm.nih.gov/pubmed/28220452
http://dx.doi.org/10.1186/s13613-017-0244-y
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