Early thrombomodulin-α administration outcome for acute disseminated intravascular coagulopathy in gastrointestinal surgery

Table 1 Baseline demographics

Subjects	n = 36
Sex, F/M	12/24
Age, median (range)	71 (48-86)
Underlying disease
Perforation
Gastric	1
Small intestine	2
Colo/rectal	8
Abscess/bacteremia	12
Ileus	3
Pancreatitis	2
Pneumonia	5
Drug-induced	3
Peri-operative, no/yes	10/26
Cancer-associated, no/yes	23/13
Post-operative day, ≤ 7/> 7	21/5
Combination treatment for DIC
Unfractionated heparins	4
Anti-thrombin concentrates	28
γ-globulin agents	29
Vasopressors	26
Protease inhibitors	4
Sivelestat sodium hydrates	4
Steroid preparations	7
Dialysis	5
Blood transfusion	4

DIC: Disseminated intravascular coagulopathy.

Table 2 Patient characteristics

Subjects		n = 36
DIC scores	4	15
Before the treatment	5	9
(JAAM criteria)	6	8
	7	1
	8	3
SIRS scores	0/1	5
Before the treatment	2	9
	3	15
	4	7
qSOFA scores	0	10
Before the treatment	1	4
	2	17
	3	5
Duration of DIC	-2/-1	4
Before the administration of TM-α (d)	0	16
	1	10
	2	1
	3	4
	≥ 4	1
Duration of administration	1	5
	2	5
	3	3
	4	3
	5	9
	6	4
	≥ 7	7

DIC: Disseminated intravascular coagulopathy; JAAM: Japanese Association for Acute Medicine; qSOFA: Quick-sequential organ failure assessment; SIRS: Systemic inflammatory response syndrome. TM-α: Thrombomodulin-α.

Table 3 Reasons for discontinuation of thrombomodulin-α

Duration (d)	Total number	Cases	Reasons
1	5	2	Dialysis
		3	Bleeding tendency
2	5	3	Death
		2	Bleeding tendency
3	3	1	Resolved
		2	Bleeding tendency
4	3	3	Resolved

Table 4 Survival analysis at 28 d after thrombomodulin-α administration

Factor		n = 31	28-d survival rate	P value
Sex	Male	22	73%	0.83
	Female	9	67%
Age	≤ 70	14	64%	0.54
	> 70	17	76%
Duration of administration	≥ 4, ≤ 6	16	88%	0.03
	≤ 3, ≥ 7	15	53%
Initiation of administration after DIC (d)	≤ 1	27	74%	0.43
	≥ 2	4	50%
DIC scores before the treatment	≤ 5	21	67%	0.52
	≥ 6	10	80%
Improvement in DIC scores at 1 wk	≤ 3	14	93%	0.01
	≥ 4	17	53%
SIRS scores before the treatment	≤ 2	12	58%	0.2
	≥ 3	19	79%
Improvement in SIRS scores at 1 wk	≤ 2	21	86%	0.09
	≥ 3	7	57%
qSOFA scores before the treatment	≤ 1	11	73%	0.8
	≥ 2	20	70%
Improvement in qSOFA scores at 1 wk	≤ 1	22	91%	0.001
	≥ 2	6	33%
Sepsis	Present	20	70%	0.8
	Absent	11	73%
Shock	Present	16	81%	0.24
	Absent	15	60%
Lactate values before the treatment	≥ 2	8	75%	0.69
	< 2	18	83%

DIC: Disseminated intravascular coagulopathy; qSOFA: Quick-sequential organ failure assessment; SIRS: Systemic inflammatory response syndrome.

Table 5 Relationships between treatment initiation and patient demographics

Factor		Treatment initiation after DIC		P value
		≤ 0 d	≥ 1 d
Duration of administration	≥ 4, ≤ 6	9	7	0.94
	≤ 3, ≥ 7	11	9
DIC scores before the treatment	≤ 5	12	12	0.34
	≥ 6	8	4
SIRS scores before the treatment	≤ 2	6	8	0.22
	≥ 3	14	8
qSOFA scores before the treatment	≤ 1	3	11	0.001
	≥ 2	17	5
Sepsis	Present	17	5	0.001
	Absent	3	11
Shock	Present	13	4	0.02
	Absent	7	12
Lactate values before the treatment	≤ 3	6	10	0.02
	> 3	11	3

DIC: Disseminated intravascular coagulopathy; qSOFA: Quick-sequential organ failure assessment; SIRS: Systemic inflammatory response syndrome.