The aim of the present study was to compare the outcome of septic shock patients who received Activated Protein C (APC) in our institution from 2003 to 2008 to that of a series of patients who were case-matched in terms of characteristics and of severity but who did not receive APC while they fulfilled our criteria of treatment without presenting any contraindication.
65 patients received APC. All of them had a circulatory failure (norepinephrine dose: 6.5 ± 4.5 mg/h, blood lactate level: 4.9 ± 3.1 mmol/L) and at least one other organ failure. We searched in a regional data base from 33 ICUs (CUB-Rea) individual case-matched patients with similar characteristics in terms of age, gender, SAPS2, presence of circulatory failure, respiratory failure (need of mechanical ventilation, MV), renal failure (need of renal replacement therapy, RRT). Were excluded from the database, patients admitted in ICUs where APC is used on a regular basis and those potentially presenting a contraindication to APC treatment. Among 1748 eligible patients, 61 (coming from 21 ICUs) could be matched one-to-one with 61 patients from our ICU. Comparisons between the 2 groups used paired-tests. The impact of APC on survival was evaluated by marginal models (logistic regression and Cox model).
Between the two groups (APC+ vs. APC-) there was no difference in terms of age (60±13 vs. 60±13 yrs), SAPS2 (57±15 vs. 57±15), circulatory failure (100% vs. 100%), respiratory failure (98% vs. 98%), renal failure (68% vs. 64%) and ICU length of stay (24±26 vs. 20±18 days). The ICU mortality was markedly lower in the APC + group (26%) than in the APC- group (54%).
The use of APC was associated with a significant decrease in ICU mortality. This finding seems robust since it was confirmed in all the bootstrap samples (of 61 patients) that were generated from the 1748 eligible patients.
This study suggests that Activated Protein C exerts a beneficial effect on survival of patients with septic shock.
Jean-Louis Teboul, No Financial Disclosure Information; No Product/Research Disclosure Information