Abstract: Poster Presentations |


Rajesh Chawla, MD*; S. Kansal, MD; A. Lall, MD; M. S. Kanwar, MD; D. Rosha, MD; A. Bansal, MD; V. Sikri, MD
Author and Funding Information

Indraprastha Apollo Hospitals, Delhi, India


Chest. 2007;132(4_MeetingAbstracts):555b. doi:10.1378/chest.132.4_MeetingAbstracts.555b
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PURPOSE: Drotrecogin alfa (DA) remains the only approved drug for the specific treatment of severe sepsis. Markers of outcome in patients with severe sepsis treated using DA have not been defined.

METHODS: Fifty seven patients with severe sepsis (age 51±15 yrs, range 20–77 yrs, M:F 32:25) treating using Drotrecogin alfa (24 μ/kg/hr) were included. Demographic, clinical and laboratory profile at baseline, and during the hospital stay as well as development of complications were compared between the patients who survived and those who did not.

RESULTS: A total of 20 patients (35.1%) survived to hospital discharge. Patients received DA for a mean duration of 74.8±26.2 hrs (25–96 hrs). At baseline, a high mean bilirubin level (4.3 vs 2.1 mg%, P=0.025) was a marker of adverse outcome. None of the other demographic, clinical or laboratory parameters at baseline including the type, number and severity of organ failure or the APACHE II score were different. On follow up, the difference between the mean platelet levels (1.69 ± 1.1 vs. 1.01 ± .82, P=0.046) after 24 hours and PaO2/FiO2 ratio (224.2 ± 87.3 vs 127.5 ± 89.4, P<0.001) after 48 hours of DA therapy became statistically significant. In addition, patients who had bleeding during therapy had far worse outcome {76%vs8.3%,OR 9.1(1.1–76.3),P=0.018}.

CONCLUSION: Mortality of patients with severe sepsis remains high despite introduction of DA. Although, baseline characteristics are poor markers of outcome, early trends after the initiation of DA identify patients with adverse outcome. Bleeding is associated with an adverse outcome.

CLINICAL IMPLICATIONS: Whereas many patients with severe sepsis may qualify for DA therapy, it is difficult to identify the subgroup at the time of initiation of therapy that is lilkey to have an adverse outcome. On the other hand, patients need to be closely monitored during the early phase after initiation of DA to pick up early trends that are likely to predict outcome.

DISCLOSURE: Rajesh Chawla, No Financial Disclosure Information; No Product/Research Disclosure Information

Wednesday, October 24, 2007

12:30 PM - 2:00 PM




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