Recombinant Human Soluble Thrombomodulin and In-Hospital Mortality in Acute Pancreatitis With Disseminated Intravascular Coagulation: A Japanese Nationwide Study

OBJECTIVE: Acute pancreatitis (AP) complicated by disseminated intravascular coagulation (DIC) is associated with high mortality. Although recombinant human soluble thrombomodulin (rTM) is commonly used in clinical practice, its association with outcomes in AP has not been established. DESIGN: A nationwide, propensity score-matched, retrospective cohort study. SETTING: The Japanese Diagnosis Procedure Combination national inpatient database. PATIENTS: Adult patients hospitalized with AP and DIC between July 2010 and March 2022, who survived at least 3 days. Patients were divided into those receiving rTM within three days of admission and those who did not. Propensity score matching compared in-hospital mortality. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The analysis included 10,238 patients with AP and DIC, of whom 2,001 (19.5%) received rTM and 8,237 (80.5%) did not. Propensity score matching yielded 1,868 well-balanced pairs. In-hospital mortality was lower in the rTM group (15.5% [290/1,868]) compared with the non-rTM group (19.7% [368/1,868]; risk difference: -4.2%, 95% CI, -6.6% to -1.7%; risk ratio: 0.79, 95% CI, 0.69 to 0.91). CONCLUSIONS: Administration of rTM in patients with AP complicated by DIC was associated with lower in-hospital mortality.