[Show abstract][Hide abstract] ABSTRACT: Sepsis, severe sepsis, and septic shock are progressively severe stages of the host's systemic inflammatory response to infection.(1) The latter stages carry increasing rates of end-organ failure and death. The spectrum of the sepsis syndrome remains a leading cause of death in the United States, and early intervention with appropriate antibiotics (matching the antibiogram susceptibilities to the drugs administered) saves lives. Specific to septic shock, a large retrospective cohort study involving 2731 adults in 14 critical care units showed an absolute decrease of 7.6 percentage points in the survival rate for each hour of delay in antimicrobial administration from the . . .
New England Journal of Medicine 05/2012; 366(22):2122-4. · 54.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: There have been conflicting reports on the efficacy of recombinant human activated protein C, or drotrecogin alfa (activated) (DrotAA), for the treatment of patients with septic shock.
In this randomized, double-blind, placebo-controlled, multicenter trial, we assigned 1697 patients with infection, systemic inflammation, and shock who were receiving fluids and vasopressors above a threshold dose for 4 hours to receive either DrotAA (at a dose of 24 μg per kilogram of body weight per hour) or placebo for 96 hours. The primary outcome was death from any cause 28 days after randomization.
At 28 days, 223 of 846 patients (26.4%) in the DrotAA group and 202 of 834 (24.2%) in the placebo group had died (relative risk in the DrotAA group, 1.09; 95% confidence interval [CI], 0.92 to 1.28; P=0.31). At 90 days, 287 of 842 patients (34.1%) in the DrotAA group and 269 of 822 (32.7%) in the placebo group had died (relative risk, 1.04; 95% CI, 0.90 to 1.19; P=0.56). Among patients with severe protein C deficiency at baseline, 98 of 342 (28.7%) in the DrotAA group had died at 28 days, as compared with 102 of 331 (30.8%) in the placebo group (risk ratio, 0.93; 95% CI, 0.74 to 1.17; P=0.54). Similarly, rates of death at 28 and 90 days were not significantly different in other predefined subgroups, including patients at increased risk for death. Serious bleeding during the treatment period occurred in 10 patients in the DrotAA group and 8 in the placebo group (P=0.81).
DrotAA did not significantly reduce mortality at 28 or 90 days, as compared with placebo, in patients with septic shock. (Funded by Eli Lilly; PROWESS-SHOCK ClinicalTrials.gov number, NCT00604214.).
New England Journal of Medicine 05/2012; 366(22):2055-64. · 54.42 Impact Factor
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