ABSTRACT

We aimed to evaluate retrospectively the effect of soluble recombinant human thrombomodulin (rTM) on prognosis in patients with severe acute pancreatitis complicated by disseminated intravascular coagulation (DIC).

Based on Japanese diagnostic criteria of acute pancreatitis and DIC, patients who entered our intensive care unit (ICU) were selected. Comparisons were made between patients treated with rTM (rTM group) and without rTM (control group).

A total of 38 patients were selected, and rTM was administered to 13 patients. Mortality on the 60th day after entering the ICU was significantly lower in the rTM group (15%) as compared with the control group (56%) (p=0.036). Although the platelet count was significantly lower in the rTM group at the start of treatment, the reversal rate from DIC was significantly higher than in the control group (rTM 62%, control 24%, p=0.035). According to logistic regression analysis of therapeutics, only rTM contributed to survival on the 60th day (odds ratio, 12.5; 95% confidence interval, 1.80-160; p=0.009).

In patients with severe acute pancreatitis complicated by DIC, it was suggested that rTM might improve the prognosis of survival, even if the platelet count was markedly reduced.

Keywords: Disseminated intravascular coagulation, mortality, severe acute pancreatitis, thrombomodulin