Drotrecogin alfa (activated) for severe sepsis: Could we consider a shorter treatment period in patients with a favorable course?

• Published in: Journal of critical care 2009-12, Vol.24 (4), p.590-594
• Main Authors: Ahishakiye, David, Lorent, Sophie, De Backer, Daniel, Gottignies, Philippe, Vincent, Jean-Louis
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anti-Infective Agents - administration & dosage; Anti-Infective Agents - therapeutic use; APACHE; Arterial pH; Cost control; Critical Care; Drug Administration Schedule; Failure; Female; Hospital Mortality; Humans; Intensive care; Intensive Care Units; Length of Stay; Male; Middle Aged; Mortality; Multiple Organ Failure - etiology; Multiple Organ Failure - mortality; Multiple Organ Failure - prevention & control; Nitric oxide; Organ dysfunction; Outcome; Protein C - administration & dosage; Protein C - therapeutic use; Recombinant Proteins - administration & dosage; Recombinant Proteins - therapeutic use; Retrospective Studies; Sepsis; Sepsis - complications; Sepsis - drug therapy; Sepsis - mortality; SOFA score
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2009.03.009

Abstract Purpose The objective of this study was to develop a model to identify patients in whom drotrecogin alfa (activated) (DAA) might be administered for periods shorter than the recommended 96 hours. Methods We did a retrospective chart review of all 124 patients treated with a standard 96-hour infusion of DAA in a 31-bed department of intensive care. Using a stepwise approach, we identified and combined parameters that could help predict outcomes to achieve the best sensitivity associated with 100% specificity. Results Twenty-one (17%) of the 124 patients had a favorable outcome (left the intensive care unit within 5 days of DAA initiation); of these, 11 had an increase in arterial pH in the first 24 hours of treatment compared with 22 (21%) of the 103 patients with intermediate (intensive care unit stay >5 days after DAA initiation) or unfavorable (died within 5 days of DAA initiation) outcomes ( P = not significant). Eight (72.7%) of these 11 patients and no other patient showed a decrease in sequential organ failure assessment score of at least 50% during the first 24 hours ( P < .001). By combining these 2 variables, we could identify, with 100% specificity, 8 of the patients with a favorable outcome (38%) who made a prompt recovery. Conclusions A simple model based on sequential organ failure assessment score and arterial pH can help identify patients with a rapid favorable course in whom a shorter duration of DAA treatment may be justified.