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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 |
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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 >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.</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 & 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</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 >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.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Infective Agents - administration & dosage</subject><subject>Anti-Infective Agents - therapeutic use</subject><subject>APACHE</subject><subject>Arterial pH</subject><subject>Cost control</subject><subject>Critical Care</subject><subject>Drug Administration Schedule</subject><subject>Failure</subject><subject>Female</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Intensive care</subject><subject>Intensive Care Units</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multiple Organ Failure - etiology</subject><subject>Multiple Organ Failure - mortality</subject><subject>Multiple Organ Failure - prevention & control</subject><subject>Nitric oxide</subject><subject>Organ dysfunction</subject><subject>Outcome</subject><subject>Protein C - administration & dosage</subject><subject>Protein C - therapeutic use</subject><subject>Recombinant Proteins - administration & dosage</subject><subject>Recombinant Proteins - therapeutic use</subject><subject>Retrospective Studies</subject><subject>Sepsis</subject><subject>Sepsis - complications</subject><subject>Sepsis - drug therapy</subject><subject>Sepsis - mortality</subject><subject>SOFA score</subject><issn>0883-9441</issn><issn>1557-8615</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><recordid>eNp9kk9v1DAQxS0EokvhC3BAljgAh4RxHCcxQiC0_JUqcaB3y7En1CEbb21nqx755jjalSr1wOmNrN88jecNIc8ZlAxY83YsRxNMWQHIEniZ5QHZMCHaomuYeEg20HW8kHXNzsiTGEcA1nIuHpMzJkXb1kxuyN_PwaeAxv92M9XToOlrbZI76IT2DR18oBEPGDDLPrr4jm79Mll6g9T4OTqLgWoar3xIucpGOu1wTnSPwXlLs-deJ5dfIr1x6Sqzgz74oPtpNVhCxI9PyaNBTxGfnfScXH79crn9Xlz8_PZj--miMLyTqegqXYvWNqwZWI_QD1XXyV72thesahnvbWsqOXQoBNM16IYZnisBtcFeIj8nr462--CvF4xJ7Vw0OE16Rr9EtW6mA6h5Jl_eI8c86ZxnUww4r7is2iZT1ZEywccYcFD74HY63GZIrfGoUa3xqDUeBVxlyU0vTtZLv0N713LKIwPvjwDmTRwcBhVNXp9B63JISVnv_u__4V67mdzsjJ7-4C3Gu3-oWClQv9YDWe8DJAC0kvN_qBO2pw</recordid><startdate>20091201</startdate><enddate>20091201</enddate><creator>Ahishakiye, David</creator><creator>Lorent, Sophie</creator><creator>De Backer, Daniel</creator><creator>Gottignies, Philippe</creator><creator>Vincent, Jean-Louis</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20091201</creationdate><title>Drotrecogin alfa (activated) for severe sepsis: Could we consider a shorter treatment period in patients with a favorable course?</title><author>Ahishakiye, David ; Lorent, Sophie ; De Backer, Daniel ; Gottignies, Philippe ; Vincent, Jean-Louis</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c389t-82a457d616f1be0bf2889b9bdb512713bd7c29f8e551a40a61c351a504ceb9e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Infective Agents - administration & dosage</topic><topic>Anti-Infective Agents - therapeutic use</topic><topic>APACHE</topic><topic>Arterial pH</topic><topic>Cost control</topic><topic>Critical Care</topic><topic>Drug Administration Schedule</topic><topic>Failure</topic><topic>Female</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Intensive care</topic><topic>Intensive Care Units</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Multiple Organ Failure - etiology</topic><topic>Multiple Organ Failure - mortality</topic><topic>Multiple Organ Failure - prevention & control</topic><topic>Nitric oxide</topic><topic>Organ dysfunction</topic><topic>Outcome</topic><topic>Protein C - administration & dosage</topic><topic>Protein C - therapeutic use</topic><topic>Recombinant Proteins - administration & dosage</topic><topic>Recombinant Proteins - therapeutic use</topic><topic>Retrospective Studies</topic><topic>Sepsis</topic><topic>Sepsis - complications</topic><topic>Sepsis - drug therapy</topic><topic>Sepsis - mortality</topic><topic>SOFA score</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ahishakiye, David</creatorcontrib><creatorcontrib>Lorent, Sophie</creatorcontrib><creatorcontrib>De Backer, Daniel</creatorcontrib><creatorcontrib>Gottignies, Philippe</creatorcontrib><creatorcontrib>Vincent, Jean-Louis</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>ProQuest - Health & Medical Complete保健、医学与药学数据库</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>British Nursing Database</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest research library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of critical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ahishakiye, David</au><au>Lorent, Sophie</au><au>De Backer, Daniel</au><au>Gottignies, Philippe</au><au>Vincent, Jean-Louis</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Drotrecogin alfa (activated) for severe sepsis: Could we consider a shorter treatment period in patients with a favorable course?</atitle><jtitle>Journal of critical care</jtitle><addtitle>J Crit Care</addtitle><date>2009-12-01</date><risdate>2009</risdate><volume>24</volume><issue>4</issue><spage>590</spage><epage>594</epage><pages>590-594</pages><issn>0883-9441</issn><eissn>1557-8615</eissn><abstract>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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>19577419</pmid><doi>10.1016/j.jcrc.2009.03.009</doi><tpages>5</tpages></addata></record> |
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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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