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Abstract Background Although recombinant human soluble thrombomodulin (rTM) has been widely used to treat disseminated intravascular coagulation (DIC) in Japan, there is no consensus regarding rTM efficacy. Therefore, if the factors influencing rTM efficacy is revealed, it may be possible to demonstrate the effectiveness of rTM by limiting the patients who use rTM. This study investigated the factors of rTM treatment which influence DIC status. Methods This retrospective case-control study enrolled hospitalized adult patients treated with rTM from October 2010 to May 2020. Among these patients, 227 who were diagnosed with DIC according to the Japanese Association for Acute Medicine DIC scoring system were assessed. The primary endpoint was the 28-day mortality after rTM treatment. For Cox-proportional hazards model, explanatory factors determined using univariate analysis with p

Background Although polymyxin B cartridge hemoperfusion (PMX) has an important place in the treatment of patients with severe sepsis and/or septic shock (SS), there are few rigid indications for performing PMX a second time.The objective of the study was to investigate the clinicolaboratory characteristics (CCs) showing the most significant change from the first to the second PMX and associated with 28-d mortality in patients with SS. Methods Between April 2006 and March 2008, 78 patients with SS who had received two sessions of PMX in a prospectively collected multicenter collaboration study were enrolled. Univariate and multivariate analyses using the differences in the values of individual CCs (Δ-CCs) were performed to assess the CCs showing the most significant change in value associated with 28-d mortality. The Δ-CC was defined as: Δ 2nd-1st -CC = value of the CC just before the second PMX − value of the CC just before the first PMX. Results Among 28 Δ 2nd-1st -CCs, 10 Δ 2nd-1st -CCs were selected by using receiver operating characteristic (ROC) curve analyses. The results of multivariate analysis using adequate 8 Δ 2nd-1st -CCs that had been selected by univariate analyses revealed that only Δ 2nd-1st -prothrombin time–international normalized ratio (PT-INR) (≤0.16/>0.16; hazard ratio = 6.562; 95% CI = 1.525–28.23; P = 0.012) was associated with 28-d mortality. Survival curve analysis demonstrated a significant difference in 28-d mortality between patients with a lower (≤0.16) and a higher (>0.16) Δ 2nd-1st -PT-INR ( P < 0.001). Conclusions Patients with exacerbation of PT-INR (>0.16) after initial PMX are unlikely to benefit clinically from a second PMX for treatment of SS. [ABSTRACT FROM AUTHOR]