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.
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.
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.
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.
RhAPC when given before or after 24 hours appeared to be beneficial in severe sepsis.
Narinder Gill, No Financial Disclosure Information; No Product/Research Disclosure Information