Impact of Different Treatments for Disseminated Intravascular Coagulation on Patients with or without Biliary Drainage for Severe Biliary Tract Infection

Figures & data

Table 1 Baseline Clinical Characteristics of Patient Categorized into Two Groups with and without Biliary Drainage

	Biliary Drainage		P value
	Presence (n = 45)	Absence (n = 26)
Age, median (range)	79 (50–96)	76 (48–102)	0.830
Sex, male, n (%)	26 (58)	12 (46)	0.344
APACHE-II score, mean ± SD	16 ± 5.4	15 ± 4.6	0.256
SOFA score, mean ± SD	7.7 ± 2.9	7.3 ± 3.3	0.607
JAAM DIC score, mean ± SD	6.0 ± 1.2	5.6 ± 1.2	0.756
Albumin (g/dL), mean ± SD	2.5 ± 0.7	2.4 ± 0.8	0.507
Total bilirubin (mg/dL), mean ± SD	3.8 ± 3.0	3.7 ± 4.2	0.882
AST(U/L), mean ± SD	197 ± 251	298 ± 620	0.337
ALT(U/L), mean ± SD	152 ± 179	181 ± 240	0.557
γ-GTP(IU/L), mean ± SD	260 ± 208	224 ± 231	0.502
ALP(IU/mL), mean ± SD	998 ± 803	1052 ± 1468	0.841
CRP (mg/dl), mean ± SD	22 ± 8.0	18 ± 10	0.069
rTM preparation, n (%)	35 (78)	19 (73)	0.655
AT replacement therapy, n (%)	10 (22)	7 (27)	0.655
Intravenous immunoglobulin, n (%)	12 (27)	3 (12)	0.132
PMX-HP, n (%)	3 (6.7)	1 (3.8)	0.619
Mechanical ventilation, n (%)	4 (8.9)	3 (12)	0.718
Improvement of DIC, n (%)	30 (67)	19 (73)	0.574
28-day mortality, n (%)	16 (36)	11 (42)	0.487
Antibiotics, n (%)			0.312
SBT/CPZ	23 (51)	10 (38)
TAZ/PICC	8 (18)	5 (19)
MEPM	9 (20)	3 (12)
DRPM	3 (7)	5 (19)
CZOP	2 (4)	3 (12)

Abbreviations: APACHE-II, Acute Physiology and Chronic Health Evaluation II; SOFA, Sequential Organ Failure Assessment; JAAM, Japanese Association for Acute Medicine; AST, aspartate aminotransferase; ALT, alanine aminotransferase; γ-GTP, γ-glutamyl transpeptidase; ALP, alkaline phosphatase; CRP, C-reactive protein; rTM, recombinant thrombomodulin; AT, antithrombin; PMX-HP, Polymyxin B hemoperfusion; DIC, disseminated intravascular coagulation; SBT/CPZ, Sulbactam/Cefoperazone; TAZ/PIPC, Tazobactam/Piperacillin; MEPM, Meropenem; DRPM, Doripenem; CZOP, Cefozopran.

Figure 1 Estimated overall survival rates for patients categorized into two groups with and without biliary drainage.

Notes: An orange line and a black line show survival curve for patients treated with biliary drainage (n = 45) and without drainage (n = 26), respectively. Log rank test resulted that there was no significant difference between two groups (P = 0.533).

Figure 2 Estimated overall survival rates for patients with biliary drainage.

Notes: A blue and a green line show survival curve for patients treated by rTM preparation (n = 35) and AT replacement therapy (n = 10), respectively. There was no statistically significant difference between rTM preparation and AT replacement therapy in the 60-day OS (P = 0.219).

Abbreviations: rTM, recombinant thrombomodulin; AT, antithrombin; OS, overall survival.

Figure 3 Estimated overall survival rates for patients without biliary drainage.

Notes: A blue and a green line show survival curve for patients treated by rTM preparation (n = 19) and AT replacement therapy (n = 7), respectively. There was a statistically significant difference between rTM preparation and AT replacement therapy in the 60-day OS (P = 0.011).

Abbreviations: rTM, recombinant thrombomodulin; AT, antithrombin; OS, overall survival.

Table 2 Clinical Characteristics of Patient’s Background Data of the rTM Preparation and at Replacement Therapy Group

	Anti-DIC Treatment		P value
	rTM (n = 54)	AT (n = 17)
Age, median (range)	79(48–102)	77(60–91)	0.441
Sex, male, n (%)	32(59)	6(35)	0.084
APACHE-II score, mean ± SD	15 ± 4.8	16 ± 6.4	0.835
SOFA score, mean ± SD	7.5 ± 2.8	8.0 ± 3.6	0.527
JAAM DIC score, mean ± SD	5.7 ± 1.2	6.6 ± 0.8	0.002
Albumin (g/dL), mean ± SD	2.6 ± 0.7	2.0 ± 0.6	0.003
Total bilirubin (mg/dL), mean ± SD	4.0 ± 3.7	3.1 ± 2.5	0.325
AST(U/L), mean ± SD	210 ± 256	313 ± 748	0.386
ALT(U/L), mean ± SD	173 ± 203	129 ± 200	0.437
γ-GTP(IU/L), mean ± SD	263 ± 217	196 ± 211	0.262
ALP(IU/mL), mean ± SD	919 ± 697	1330 ± 1844	0.174
CRP (mg/dl), mean ± SD	21 ± 9.5	21 ± 8.1	0.833
Biliary drainage, n (%)	35(65)	10(59)	0.720
Intravenous immunoglobulin, n (%)	13(24)	2(12)	0.278
PMX-HP, n (%)	2(3.7)	2(12)	0.209
Mechanical ventilation, n (%)	3(5.6)	4(24)	0.030
Improvement of DIC, n (%)	41(74)	8(47)	0.025
28-day mortality, n (%)	15(28)	12(71)	0.002
Antibiotics			0.015
SBT/CPZ	20 (37)	13 (76)
TAZ/PICC	13 (24)	0
MEPM	11 (20)	1 (6)
DRPM	5 (9)	3 (18)
CZOP	5 (9)	0

Abbreviations: APACHE-II, Acute Physiology and Chronic Health Evaluation II; SOFA, Sequential Organ Failure Assessment; JAAM, Japanese Association for Acute Medicine; AST, aspartate aminotransferase; ALT, alanine aminotransferase; γ-GTP, γ-glutamyl transpeptidase; ALP, alkaline phosphatase; CRP, C-reactive protein; PMX-HP, Polymyxin B hemoperfusion; DIC, disseminated intravascular coagulation; SBT/CPZ, Sulbactam/Cefoperazone; TAZ/PIPC, Tazobactam/Piperacillin; MEPM, Meropenem; DRPM, Doripenem; CZOP, Cefozopran.

Figure 4 Estimated overall survival rates for patients with cholangitis-associated DIC treated by rTM preparation or AT replacement therapy.

Notes: A blue and a green line show survival curve for patients treated by rTM preparation (n = 54) and AT replacement therapy (n = 17), respectively. There was a statistically significant difference between rTM preparation and AT replacement therapy in the 60-day OS (P = 0.022).

Abbreviations: DIC, disseminated intravascular coagulation; rTM, recombinant thrombomodulin; AT, antithrombin; OS, overall survival.