Trial reportCritical care (London, England)2010
Drotrecogin alfa (activated) may attenuate severe sepsis-associated encephalopathy in clinical septic shock.
Trial report in Critical care (London, England), 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
14 citing papers in PubMed, 2 syntheses or guidelines pooled it, 40 citations in OpenAlex.
- Diagnostic and prognostic value of serum S100B in sepsis-associated encephalopathy: A systematic review and meta-analysis.Frontiers in immunology · 2023Pooled it
- Biomarkers in septic encephalopathy: a systematic review of clinical studies.Revista Brasileira de terapia intensiva · 2013Pooled it
- Paediatric sepsis-associated encephalopathy (SAE): a comprehensive review.Molecular medicine (Cambridge, Mass.) · 2023Review
- Effects of hydrogen-rich saline in neuroinflammation and mitochondrial dysfunction in rat model of sepsis-associated encephalopathy.Journal of translational medicine · 2022Article
- Septic Encephalopathy.Current neurology and neuroscience reports · 2018Review
- Sepsis Associated Encephalopathy.Advances in medicine · 2014Review
- Understanding brain dysfunction in sepsis.Annals of intensive care · 2013Article
- Associations of markers of inflammation and coagulation with delirium during critical illness.Intensive care medicine · 2012Article
- [Septic encephalopathy].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2012Review
- Sepsis-associated encephalopathy.Translational medicine @ UniSa · 2012Article
- Mitochondrial DNA haplogroup R in the Han population and recovery from septic encephalopathy.Intensive care medicine · 2011Article
- Year in review 2010: Critical Care--Neurocritical care.Critical care (London, England) · 2011Review
- Sepsis-associated encephalopathy: not just delirium.Clinics (Sao Paulo, Brazil) · 2011Review
- Sparing brain damage in severe sepsis: a beginning.Critical care (London, England) · 2010Article
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionSepsis-associated encephalopathy (SAE) is a diffuse cerebral dysfunction induced by the immuno-inflammatory response to infection. Elevated levels of the brain-specific S100B protein are present in many septic patients and reflect the severity of SAE. Adjunctive treatment with drotrecogin alfa (activated) (DrotAA), the human recombinant form of activated protein C, has been shown to improve mortality in patients with severe sepsis-induced organ failure. We studied the effect of DrotAA on S100B levels in patients with acute septic shock who presented with increased baseline values of this biomarker.
methodsAll patients received standard goal-directed resuscitation treatment. Patients with pre-existing or acute neurological disorders were excluded. Based on the Glasgow coma scale (GCS), patients were classified into two groups: GCS >or= 13 and GCS <13. DrotAA was given as a continuous infusion of 24 microg/kg/h for 96 h. S100B was measured before sedation and the start of DrotAA (0 h) and at 32 h, 64 h and 96 h and at corresponding time points in patients not treated with DrotAA. The lower limit of normal was < 0.5 microg/L.
resultsFifty-four patients completed the study. S100B was increased in 29 (54%) patients. Twenty-four patients (9 with GCS >or= 13 and 15 with GCS <13) received DrotAA. S100B levels in DrotAA-treated patients with a GCS <13, though higher at baseline than in untreated subjects (1.21 +/- 0.22 microg/L vs. 0.95 +/- 0.12 microg/L; P = 0.07), progressively and significantly decreased during infusion (0.96 +/- 0.22 microg/L at 32 h, P = 0.3; 0.73 +/- 0.12 microg/L at 64 h, P < 0.05; and 0.70 +/- 0.13 microg/L at 96 h, P < 0.05 vs. baseline). This patient group had also significantly lower S100B values at 64 h and at 96 h than their untreated counterparts. In the patients with a GCS >or= 13, S100B levels were not influenced by DrotAA treatment.
conclusionsS100B-positivity is present in more than half of the patients with septic shock. When increased S100B levels are used as a surrogate for SAE, adjunctive DrotAA treatment seems to beneficially affect the evolution of severe SAE as discriminated by an admission GCS <13.
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