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Protein C Levels in Severe Sepsis

Steven M. Opal, MD
Author and Funding Information

Affiliations: Pawtucket, RI 
 ,  Dr. Opal is Professor of Medicine, Brown University School of Medicine.

Correspondence to: Steven M. Opal, Infectious Disease Division, Memorial Hospital of Rhode Island, 111 Brewster St, Pawtucket, RI 02860



Chest. 2001;120(3):699-701. doi:10.1378/chest.120.3.699
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In this issue of CHEST (see page 915), Yan and colleagues demonstrate that 90% of a population of 70 patients who met the standard clinical criteria for severe sepsis had significantly reduced protein C levels. These investigators examined plasma samples from patients at study entry from a multicenter sepsis trial (the ibuprofen study1) and repeated coagulation assays on plasma samples from patients 44 h after study entry. While low baseline levels of protein C portend an unfavorable outcome, the results at 44 h after study entry were more predictive of fatal outcome (p < 0.05). These results are consistent with a considerable body of literature attesting to the adverse prognostic significance of low protein C levels in patients with severe sepsis.24 In addition to a rather predictable “dose-response” relationship (lower protein C levels, higher mortality rate), this study and several other recent investigations have documented that the failure of low protein C levels to recover in septic patients is highly correlated with a poor prognosis.4

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