ArticleCritical care medicine2012
Activated protein C and septic shock: a propensity-matched cohort study*.
Article in Critical care medicine, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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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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Who cites it
13 citing papers in PubMed, 30 citations in OpenAlex.
- Endothelial dysfunction and immunothrombosis in sepsis.Frontiers in immunology · 2023Review
- White blood cell count trajectory and mortality in septic shock: a historical cohort study.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2022Article
- Keeping It Simple in Sepsis Measures.Journal of hospital medicine · 2017Article
- Association Between Hospital Case Volume of Sepsis, Adherence to Evidence-Based Processes of Care and Patient Outcomes.Critical care medicine · 2017Article
- Antithrombin III and D-dimer levels as indicators of disease severity in patients with hyperlipidaemic or biliary acute pancreatitis.The Journal of international medical research · 2017Observational
- The effect of sepsis and its inflammatory response on mechanical clot characteristics: a prospective observational study.Intensive care medicine · 2016Observational
- Anticoagulant modulation of inflammation in severe sepsis.World journal of critical care medicine · 2015Review
- Man is the new mouse: Elective surgery as a key translational model for multi-organ dysfunction and sepsis.Journal of the Intensive Care Society · 2015Article
- The efficacy of activated protein C for the treatment of sepsis: incorporating observational evidence with a Bayesian approach.BMJ open · 2015Article
- Trends in infection source and mortality among patients with septic shock.American journal of respiratory and critical care medicine · 2014Article
- Why activated protein C was not successful in severe sepsis and septic shock: are we still tilting at windmills?Current infectious disease reports · 2013Article
- The aPC treatment improves microcirculation in severe sepsis/septic shock syndrome.BMC anesthesiology · 2013Article
- [Lost in translation? On the effectiveness and efficacy of drotrecogin alfa (recombinant human activated protein C)].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2013Article
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Authors and funding
17 authors at 1 institution in 1 country.
Funding
Abstract
backgroundSeptic shock is a highly inflammatory and procoagulant state associated with significant mortality. In a single randomized controlled trial, recombinant human activated protein C (drotrecogin alfa) reduced mortality in patients with severe sepsis at high risk of death. Further clinical trials, including a recently completed trial in patients with septic shock, failed to reproduce these results.
objectiveTo evaluate the effectiveness of recombinant human activated protein C on mortality in a cohort of patients with septic shock and to explore possible reasons for inconsistent results in previous studies.
designRetrospective, 2:1 propensity-matched, multicenter cohort study.
settingTwenty-nine academic and community intensive care units in three countries. PATIENTS: Seven thousand three hundred ninety-two adult patients diagnosed with septic shock, of which 349 received recombinant human activated protein C within 48 hrs of intensive care unit admission between 1997 and 2007. MEASUREMENTS AND MAIN
resultsOur primary outcomes were mortality over 30 days and mortality stratified by Acute Physiology and Chronic Health Evaluation II quartile. Using a propensity-matched Cox proportional hazard model, we observed a 6.1% absolute reduction in 30-day mortality associated with the use of recombinant human activated protein C (108/311 [34.7%] vs. 254/622 [40.8%], hazard ratio 0.72, 95% confidence interval 0.52-1.00, p = .05) and noted consistent reductions in mortality among Acute Physiology and Chronic Health Evaluation II quartiles. A time to event analysis showed that the time to appropriate antimicrobials after documented hypotension decreased for each year of study (p = .003), a finding that was congruent with a decrease in annual mortality over the study period (odds ratio 0.96 per year [95% confidence interval 0.93-0.99], p = .003).
conclusionsIn this retrospective, propensity-matched, multicenter cohort study of patients with septic shock, early use of recombinant human activated protein C was associated with reduced mortality. Improvements in general quality of care such as speed of antimicrobial delivery leading to decreasing mortality of patients with septic shock may have contributed to the null results of the recently completed trial of recombinant human activated protein C in patients with septic shock.
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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.