Abstract

Nafamostat mesylate (NM) is a synthetic serine protease inhibitor that can be used as an anticoagulant during blood purification in critically ill patients, as well as a treatment for disseminated intravascular coagulation. Although NM has been reported to reduce the risk of bleeding during blood purification, its effect on survival outcomes of patients who received blood purification treatments is unclear. We hypothesized that administration of NM during blood purification can reduce mortality in patients with sepsis. A post hoc analysis was conducted on a nationwide retrospective registry that included data from 3195 sepsis patients registered at 42 intensive care units throughout Japan. We evaluated the effect of NM on hospital mortality and bleeding complications using propensity score matching in 1216 sepsis patients who underwent blood purification in the intensive care unit (ICU). Two-hundred-and-sixty-eight pairs of propensity score-matched patients who received NM and conventional therapy were compared. Hospital and ICU mortality rates in the NM group were significantly lower than those in the conventional therapy group. However, rates of bleeding complications did not differ significantly between the two groups. These data suggest that administration of NM improved the survival outcomes of sepsis patients who underwent blood purification in the ICU.

Highlights

  • Sepsis is a life-threatening condition characterized by a systemic dysregulated immune response induced by infection, causing multiple organ dysfunction as well as high mortality [1]

  • This study was conducted as a post hoc analysis of a retrospective cohort dataset of consecutive adult patients admitted to 42 intensive care units (ICU) at 40 institutions throughout Japan and treated for severe sepsis or septic shock between January 2011 and December 2013 (the Japan Septic Disseminated Intravascular Coagulation (J-Septic disseminated intravascular coagulation (DIC)) registry) [19]

  • We evaluated the effect of Nafamostat mesylate (NM) on survival outcomes using propensity score matching in patients who underwent blood purification in the ICU

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Summary

Introduction

Sepsis is a life-threatening condition characterized by a systemic dysregulated immune response induced by infection, causing multiple organ dysfunction as well as high mortality [1]. Development of the systemic inflammatory response occurs through mediators such as cytokines and/or endotoxins [4] These mediators cause activation of blood cells, such as neutrophils and platelets, followed by vascular endothelial damage, vascular hyperpermeability, and multiple organ failure and septic shock. Blood purification, such as cytokine or endotoxin removal, has been attempted as an adjunctive therapy to control these mediators and the following host response [5]

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