SynthesisThe Cochrane database of systematic reviews2011
Human recombinant activated protein C for severe sepsis.
Synthesis in The Cochrane database of systematic reviews, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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.
The trial behind it
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
21 citing papers in PubMed, 4 syntheses or guidelines pooled it, 44 citations in OpenAlex.
- Influence of therapeutic plasma exchange treatment on short-term mortality of critically ill adult patients with sepsis-induced organ dysfunction: a systematic review and meta-analysis.Critical care (London, England) · 2024Pooled it
- High-volume haemofiltration for sepsis in adults.The Cochrane database of systematic reviews · 2017Pooled it
- Human recombinant protein C for severe sepsis and septic shock in adult and paediatric patients.The Cochrane database of systematic reviews · 2012Pooled it
- Recombinant human activated protein C for severe sepsis in neonates.The Cochrane database of systematic reviews · 2012Pooled it
- Iron-withdrawing anti-infectives for new host-directed therapies based on iron dependence, the Achilles' heel of antibiotic-resistant microbes.Environmental chemistry letters · 2021Review
- Targeting coagulation activation in severe COVID-19 pneumonia: lessons from bacterial pneumonia and sepsis.European respiratory review : an official journal of the European Respiratory Society · 2020Review
- A Systematic Summary of Systematic Reviews on Anticoagulant Therapy in Sepsis.Journal of clinical medicine · 2019Review
- Activated protein C binds directly to Tie2: possible beneficial effects on endothelial barrier function.Cellular and molecular life sciences : CMLS · 2017Article
- SYSTEM-WIDE MAPPING OF ACTIVATED CIRCUITRY IN EXPERIMENTAL SYSTEMIC INFLAMMATORY RESPONSE SYNDROME.Shock (Augusta, Ga.) · 2016Article
- Neonatal brain injury and systemic inflammation: modulation by activated protein C ex vivo.Clinical and experimental immunology · 2015Article
- Overexpression of activated protein C hampers bacterial dissemination during pneumococcal pneumonia.BMC infectious diseases · 2014Article
- Purification of protein C from canine plasma.BMC veterinary research · 2014Article
- An integrated transcriptome and expressed variant analysis of sepsis survival and death.Genome medicine · 2014Article
- [Neutropenia and sepsis].Der Internist · 2013Article
- Sepsis chronically in MARS: systemic cytokine responses are always mixed regardless of the outcome, magnitude, or phase of sepsis.Journal of immunology (Baltimore, Md. : 1950) · 2012Article
- [Post-resuscitation syndrome. Role of inflammation after cardiac arrest].Der Anaesthesist · 2012Review
- A key role for the endothelium in NOD1 mediated vascular inflammation: comparison to TLR4 responses.PloS one · 2012Article
- Factor XI-deficient mice display reduced inflammation, coagulopathy, and bacterial growth during listeriosis.Infection and immunity · 2012Article
- The coagulopathy in sepsis: significance and implications for treatment.Pediatric reports · 2011Article
- Year in review 2010: Critical Care--Multiple organ dysfunction and sepsis.Critical care (London, England) · 2011Review
Corrections and comments
- Updated by
- Update of
Authors and funding
4 authors at 4 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSepsis is a common and frequently fatal condition. Human recombinant activated protein C (APC) has been used to reduce the high rate of death by severe sepsis or septic shock. This is an update of a Cochrane review (originally published in 2007 and updated in 2008).
objectivesWe assessed the clinical effectiveness and safety of APC for the treatment of patients with severe sepsis or septic shock. SEARCH STRATEGY: For this updated review we searched CENTRAL (The Cochrane Library 2010, Issue 6); MEDLINE (1966 to June 2010); EMBASE (1980 to July 1, 2010); BIOSIS (1965 to July 1, 2010); CINAHL (1982 to 16 June 2010) and LILACS (1982 to 16 June 2010). There was no language restriction. SELECTION CRITERIA: We included randomized controlled trials (RCTs) assessing the effects of APC for severe sepsis in adults and children. We excluded studies on neonates. We considered all-cause mortality at day 28, at the end of study follow up, and hospital mortality as the primary outcomes. DATA COLLECTION AND ANALYSIS: We independently performed study selection, risk of bias assessment and data extraction. We estimated relative risks (RR) for dichotomous outcomes. We measured statistical heterogeneity using the I(2) statistic. We used a random-effects model. MAIN
resultsWe identified one new RCT in this update. We included a total of five RCTs involving 5101 participants. For 28-day mortality, APC did not reduce the risk of death in adult participants with severe sepsis (pooled RR 0.97, 95% confidence interval (CI) 0.78 to 1.22; P = 0.82, I(2) = 68%). APC use was associated with an increased risk of bleeding (RR 1.47, 95% CI 1.09 to 2.00; P = 0.01, I(2) = 0%). In paediatric patients, APC did not reduce the risk of death (RR 0.98, 95% CI 0.66 to 1.46; P = 0.93). Although the included trials had no major limitations most of them modified their original completion or recruitment protocols. AUTHORS'
conclusionsThis updated review found no evidence suggesting that APC should be used for treating patients with severe sepsis or septic shock. Additionally, APC is associated with a higher risk of bleeding. Unless additional RCTs provide evidence of a treatment effect, policy-makers, clinicians and academics should not promote the use of APC.
Indexed as
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.