rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2019-5-34-43rmt-1816Research ArticleКЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯ И ПРАКТИКАCLINICAL STUDIES AND PRACTICEЗаместительная терапия препаратами антитромбина в комплексном лечении сепсисаSupplementation therapy with Antithrombin Drugs in the Combined Treatment of SepsisРедкинИ. В.RedkinI. V.

Россия, 129110, г. Москва, ул. Щепкина, д. 61/2

61/2 Shchepkin Str., Moscow 129110, Russia

 

redkin70@mail.ruЛопатинА. Ф.LopatinA. F.

Россия, 129110, г. Москва, ул. Щепкина, д. 61/2

61/2 Shchepkin Str., Moscow 129110, Russia

 

ЯворовскийА. Г.YavorovskiyA. G.

Россия, 119991, г. Москва, ул. Трубецкая, д. 8, стр. 2

8 Trubetskaya Str., Bldg. 2, 119991 Moscow, Russia

ЛихванцевВ. В.LikhvantsevV. V.

Россия, 129110, г. Москва, ул. Щепкина, д. 61/2

Россия, 119991, г. Москва, ул. Трубецкая, д. 8, стр. 2

61/2 Shchepkin Str., Moscow 129110, Russia

8 Trubetskaya Str., Bldg. 2, 119991 Moscow, Russia

Московский областной научно-исследовательский клинический институт им. М. Ф. ВладимирскогоРоссияM. F. Vladimirsky Moscow Regional Research Clinical InstituteRussian FederationПервый Московский государственный медицинский университет им. И. М. Сеченова Минздрава РоссииРоссияI. M. Sechenov First Moscow State Medical University, Ministry of Health of RussiaRussian FederationМосковский областной научно-исследовательский клинический институт им. М. Ф. Владимирского, Первый Московский государственный медицинский университет им. И. М. Сеченова Минздрава РоссииРоссияM. F. Vladimirsky Moscow Regional Research Clinical Institute, I. M. Sechenov First Moscow State Medical University, Ministry of Health of RussiaRussian Federation2019071120191553443Copyright © Редкин И.В., Лопатин А.Ф., Яворовский А.Г., Лихванцев В.В., 20192019Редкин И.В., Лопатин А.Ф., Яворовский А.Г., Лихванцев В.В.Redkin I.V., Lopatin A.F., Yavorovskiy A.G., Likhvantsev V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.reanimatology.com/rmt/article/view/1816

Цель работы — оценить эффективность применения заместительной терапии недостаточности антитромбина при комплексном лечении сепсиса.Материал и методы. Провели проспективно — ретроспективное исследования эффективности заместительной терапии недостаточности антитромбина при сепсисе; обследованы 90 пациентов. В зависимости от того, проводили ли коррекцию недостаточности антитромбина, пациентов разделили на две группы. Первичной точкой исследования выбрали композитный исход — частоту развития осложнений со стороны сердечно-сосудистой системы через 28 дней после начала лечения. Вторичные точки исследования — частота развития неблагоприятных событий на 28 день от начала лечения и 180 дневная летальность.Результаты. Группы не различались между собой ни по 28-дневной летальности, ни по композитному исходу. При анализе вторичных точек выявили, что в группе пациентов получавших заместительную терапию антитромбином, риск развития острого почечного повреждения был существенно ниже на 28 и 180 сутки от начала лечения: OR 3,5 [95% CI 1,05–11,66] при р=0,04 и OR 2,92 [95% CI 1,02–8,31] при р=0,045, соответственно.Заключение. Коррекция уровня антитромбина до уровня активности «более 61%» ассоциирована со снижением частоты развития острой почечной недостаточности III cт. (KDIGO).

Purpose — to assess the efficacy of supplementation therapy for antithrombin deficiency in the combined treatment of sepsis.Materials and methods. A prospective-retrospective study of the efficacy of supplementation therapy for antithrombin deficiency during sepsis was carried out; 90 patients were examined. The patients were split into two groups whether antithrombin deficiency correction was or was not undertaken. The composite outcome — the incidence of cardiovascular complications as of day 28 from the therapy commencement — was chosen as the primary endpoint of the study. The secondary endpoints of the study were prevalence of adverse events as of day 28 from the therapy commencement and 180-day mortality.Results. There was no difference between the groups either in respect of 28-day mortality or composite outcome. Analysis of secondary endpoints revealed that in the group of patients who received antithrombin supplementation therapy, the risk of development of an acute renal injury was significantly lower on day 28 and 180 from therapy commencement: OR 3.5 [95% CI 1.05–11.66] at P=0.04 and OR 2.92 [95% CI 1.02–8.31] at P=0.045, respectively.Conclusion. Correction of antithrombin level to activity level ‘over 61%’ is associated with decreased incidence degree III acute kidney failure (KDIGO).

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The authors declare that there are no conflicts of interest present.