Study objective: To investigate whether protein C
levels predict 30-day mortality rate, shock status, duration of ICU
stay, and ventilator dependence in patients with sepsis.
Design: Retrospective analysis of a subset of a previously
published, prospective, randomized, double-blind, placebo-controlled
trial (“Effects of Ibuprofen on the Physiology and Survival of
Patients With Sepsis” [ISS]).
multicenter study performed in the United States and Canada (seven
Patients: Seventy hospitalized patients with
acute severe sepsis and failure in one or more organs at entry into the
Measurements and Main Results: Blood
samples were obtained from all patients at baseline and at 20, 44, 72,
and 120 h after the initiation of study drug (ibuprofen or
placebo) infusion. Data obtained at these times included platelet
count, prothrombin time, and partial thromboplastin time. The results
described in this article are based on a subset of the total ISS
population for whom additional coagulation assays were performed on the
blood samples obtained at baseline and 44 h. These assays included
protein C antigen, D-dimer, and fibrinogen levels. A total of 63 of the
70 patients (90%) studied in this report had acquired protein C
deficiency at entry to the ISS trial (baseline). The presence and
severity of acquired protein C deficiency were associated with poor
clinical outcome, including lower survival rate, higher incidence of
shock, and fewer ICU-free and ventilator-free days.
Conclusions: Acquired protein C deficiency may be useful in
predicting clinical outcome in patients with sepsis. Clinical studies
are warranted to determine whether the replacement of protein C in
sepsis patients may improve outcome.