Antithrombin III and local serum application: adjuvant therapy in peritonitis

Background Patients with diffuse peritonitis show an overall mortality of a bout 20%, probably caused by the breakdown of local defence mechanisms comb ined with a systemic outspread of bacteria and toxins, which often results in sepsis syndrome. Design In a prospective, randomized, controlled study 50 patients with diff use secondary peritonitis were included. Patients in the therapy group were treated with an adjuvant medication consisting of a continuous intravenous infusion of antithrombin III and two intraperitoneal instillations of fres h frozen human donor serum. The aim of the study was the reduction of morta lity and incidence of multiple organ failure. Results Mean antithrombin III plasma levels in the therapy group were raise d above 140% for 4 days and were significantly higher than in the control g roup. With the intraperitoneal application of fresh frozen serum and antith rombin III opsonic capacity as well as thrombin, inhibitory activity in the exudate could be significantly elevated over 2 days. The 90-day-mortality rate was 6/26 (23%) in the control group and 6/24 (25%) in the therapy grou p. Although no improvement of mortality was achieved, a slight but not sign ificant reduction of the severity of the multiple organ failure was seen. Conclusions The chosen therapeutic approach was feasible and showed no side -effects. Yet, neither mortality nor multiple organ failure were significan tly improved by the applied short-term adjuvant therapy. Thus, for future t rials in severely-ill patients a longer treatment period and/or combination s of antithrombin III with other anti-inflammatory agents should be conside red.