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

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...

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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
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creator Ahishakiye, David
Lorent, Sophie
De Backer, Daniel
Gottignies, Philippe
Vincent, Jean-Louis
description 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.
doi_str_mv 10.1016/j.jcrc.2009.03.009
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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 &gt;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 &lt; .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.</description><identifier>ISSN: 0883-9441</identifier><identifier>EISSN: 1557-8615</identifier><identifier>DOI: 10.1016/j.jcrc.2009.03.009</identifier><identifier>PMID: 19577419</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Anti-Infective Agents - administration &amp; 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 &amp; control ; Nitric oxide ; Organ dysfunction ; Outcome ; Protein C - administration &amp; dosage ; Protein C - therapeutic use ; Recombinant Proteins - administration &amp; dosage ; Recombinant Proteins - therapeutic use ; Retrospective Studies ; Sepsis ; Sepsis - complications ; Sepsis - drug therapy ; Sepsis - mortality ; SOFA score</subject><ispartof>Journal of critical care, 2009-12, Vol.24 (4), p.590-594</ispartof><rights>Elsevier Inc.</rights><rights>2009 Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c389t-82a457d616f1be0bf2889b9bdb512713bd7c29f8e551a40a61c351a504ceb9e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19577419$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ahishakiye, David</creatorcontrib><creatorcontrib>Lorent, Sophie</creatorcontrib><creatorcontrib>De Backer, Daniel</creatorcontrib><creatorcontrib>Gottignies, Philippe</creatorcontrib><creatorcontrib>Vincent, Jean-Louis</creatorcontrib><title>Drotrecogin alfa (activated) for severe sepsis: Could we consider a shorter treatment period in patients with a favorable course?</title><title>Journal of critical care</title><addtitle>J Crit Care</addtitle><description>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 &gt;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 &lt; .001). 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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
title Drotrecogin alfa (activated) for severe sepsis: Could we consider a shorter treatment period in patients with a favorable course?
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