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Reducing the risk of developing walled‐off necrosis in patients with acute necrotic collection using recombinant human soluble thrombomodulin
Author(s) -
Eguchi Takaaki,
Tsuji Yoshihisa,
Okada Akihiko,
Inoue Dai,
Tokumasu Hironobu,
Iwane Kosuke,
Nakai Yoshitaka,
Kusaka Toshihiro,
Uenoyama Yoshito,
Fujita Koichi,
Yokode Masataka,
Yamashita Yukimasa,
Sawai Yugo,
Asada Masanori,
Mikami Takao,
Kawanami Chiharu,
Kudo Yasushi,
Yazumi Shujiro,
Sanuki Tsuyoshi,
Sakai Arata,
Morita Toshihiro,
Sakuma Yojiro,
Uza Norimitsu,
Takada Yutaka,
Itani Toshinao,
Kuriyama Katsutoshi,
Matsumura Kazuyoshi,
Ikeda Kazuki,
Someda Hitoshi,
Funatsu Eiji,
Katsushima Shinji,
Kodama Yuzo,
Seno Hiroshi
Publication year - 2021
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.1015
Subject(s) - medicine , thrombomodulin , acute pancreatitis , necrosis , gastroenterology , magnetic resonance imaging , surgery , radiology , thrombin , platelet
Background/Purpose The purpose of the present study was to investigate the possibility of reducing clinical impacts of acute necrotic collection (ANC) on patients with acute pancreatitis (AP) using recombinant human soluble thrombomodulin (rTM). Methods In this retrospective multicenter study, 233 consecutive AP patients with ANC and acute peripancreatic fluid collection (APFC) from 2012 to 2016 were enrolled. To assess clinical impacts of ANC, severity on admission (JPN score, JPN CT grade, and Modified CT severity index), development of walled‐off necrosis (WON), imaging costs for follow‐up, and mortality were recorded. Finally, we investigated whether rTM could reduce the clinical impacts, adjusting the severity using propensity analysis with Inverse probability of treatment weighting. Results Patients with ANC developed WON with higher ratio than APFC (58/98 [59.2%] vs 20/135 [14.8%], OR = 8.3, P < .01]. Severity on admission and imaging costs for follow‐up in ANC patients were significantly higher than those in APFC ( P < .01). However, regarding mortality, there was no significant difference between patients with ANC and APFC ( P = .41). Adjusting severity, it was revealed that rTM administration significantly reduced the risk of ANC developed WON (OR = 0.23, P = .01). Conclusions While ANC had a higher clinical impact than that of APFC, we found that early administration of rTM may reduce the impact.