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IMPACT OF RECOMBINANT HUMAN ACTIVATED PROTEIN C (RHAPC) IN TREATMENT OF SEPTIC SHOCK IN A COMMUNITY HOSPITAL: IMPACT STUDY FREE TO VIEW

Narinder S. Gill, *; Linda Hamidjaja, MD; Bing Shen, MD; Vijay P. Balasubramanian, MD
Author and Funding Information

UCSF Fresno, Fresno, CA


Chest


Chest. 2009;136(4_MeetingAbstracts):44S-h-45S. doi:10.1378/chest.136.4_MeetingAbstracts.44S-h
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Abstract

PURPOSE:  In controlled trials with strict protocols, treatment of severe sepsis with RhAPC has been shown to reduce mortality. However, in “real-life” these criteria may not be applied. Our objective was to study the characteristics and outcomes of patients treated with RhAPC in clinical practice in a community hospital.

METHODS:  We conducted a retrospective analysis of 36 cases who had received RhAPC for severe sepsis/septic shock in a 2-year period. Data included demographics, clinical variables and calculated Apache II score.

RESULTS:  Mean age of patients was 54.78±14.78, mean Apache II score was 24.11±6.44 of which 75% survived (mean Apache II 23.7±7.2) and 25% deceased (mean Apache II 25.3±3.0). 23 patients received ≥50% RhAPC dose (20 survived and 3 deceased) and 13 patients received 0–49% RhAPC dose (7 survived and 6 deceased, p=0.08). 25 patients received drug in < 24 hours (17 survived and 8 deceased). 11 patients received drug in >24h (10 survived with 1 death, p=0.28). Of 18 patients with Apache II <25, 14 survived and 4 deceased; 18 patients with Apache II ≥ 25, 13 survived and 5 deceased (p=0.70). 20 patients were blood culture positive(16 survived, 4 deceased), 16 were culture negative (11 survived, 5 deceased). 7 patients had ≤ 2 organ dysfunction (6 survived, 1 deceased), 29 patients had >2 organ dysfunction (21 survived and 8 deceased, p=0.46). 3 patients with no comorbidities prior to diagnosis of sepsis had 100% survival; Of 9 with single comorbidity 8 survived and 1 deceased; Of 24 patients with multiple comorbidities 16 survived and 8 deceased (p=0.24). Out of 36 patients only 1 had serious bleeding event.

CONCLUSION:  RhAPC was beneficial in treatment of sepsis.The Survival advantage was more apparent in patients who received more than 50% of the target dose. Culture positive patients appeared to have better survival. Higher number of comorbidities and organ dysfunctions carried higher risk of mortality.

CLINICAL IMPLICATIONS:  RhAPC when given before or after 24 hours appeared to be beneficial in severe sepsis.

DISCLOSURE:  Narinder Gill, No Financial Disclosure Information; No Product/Research Disclosure Information

Tuesday, November 3, 2009

2:30 PM - 3:30 PM


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