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2013, Number 3

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Med Crit 2013; 27 (3)

Use of activated protein C in the treatment of severe sepsis and septic shock

Villagómez-Ortiz A, Medellín R, Trujillo N, Méndez R, Guzmán R, Rosas V, García S

Language: Spanish
References: 51
Page: 153-171
PDF size: 261.63 Kb.


ABSTRACT

Background: Severe sepsis and septic shock has mortality ~50%, it is the main cause of admission to adults intensive care units. PROWESS trial showed reduction in mortality in 6.1%, in 2001, the FDA authorized the use of activated protein C for these patients; subsequent studies have had great disparity in their results.
Objective: Evaluate mortality at 28 days in patients with severe sepsis treated with activated protein C compared with a control group.
Material and methods: We conducted a clinical research in natural conditions, comparative, no randomized, open and analytic in patients with septic shock or severe sepsis. Control group was treated with activated protein C and control group in intensive care unit of Hospital Regional 1º de October from January 2007 to December 2009.
Results: Two hundred patients with severe sepsis were enrolled and divided into two groups with 100 patients each one (treated with two thousand and controls). Both groups were similar at admission moment to exception of the sex. The sepsis was origin respiratory in 43% and abdominal in 41%, during the follow-up there were greater liver failure in the treated group (72/44) (p ‹ 0.001) There was no difference in mortality between both groups. The factors that impacted on the mortality were: age (p ‹ 0.01), the time of vasopresors drug administration (p ‹ 0.003), involved lung (p 0.004) and renal (p ‹ 0,002).
Conclusions: We found no difference in mortality and greater risk of bleeding in patients treated with activated protein C. Our trial has the advantage of having been done in real-conditions.


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