| Activated protein C and hospital mortality in septic shock: a propensity-matched analysis. | |
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MedLine Citation:
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PMID: 20154607 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Evidence regarding the efficacy and safety of human recombinant activated protein C in severe sepsis is limited, especially outside of clinical trials. We sought to compare the outcomes of patients with septic shock who received early treatment with activated protein C to those who did not. DESIGN, SETTING, AND PATIENTS: A retrospective cohort study at 404 U.S. hospitals. We studied 33,749 patients with sepsis who were admitted to intensive care and administered antibiotics and vasopressors within 2 days of admission. MEASUREMENTS AND MAIN RESULTS: Hospital mortality, intracranial and gastrointestinal hemorrhage, major transfusion. Compared to the entire cohort, the 1576 activated protein C-treated patients included in the matched analysis were younger (mean age, 61 vs. 67), more likely to be white (70% vs. 63%), and had fewer comorbidities. Treated patients were more likely to require mechanical ventilation (77% vs. 48%), to be administered two or more vasopressors (68% vs. 41%), to undergo pulmonary artery catheterization (9% vs. 4%), and to die in the hospital (40.7% vs. 38.1%). In a propensity-matched sample in which all covariates achieved balance, receipt of activated protein C was associated with reduced hospital mortality (40.7% vs. 46.6%; risk ratio, 0.87; 95% confidence interval, 0.80-0.95). This result was insensitive to a hypothetical unmeasured confounder. A similar pattern was observed across groups stratified by age and number of organ-supportive therapies. Four activated protein C-treated patients (0.25%) had hemorrhagic stroke, 107 (6.8%) had gastrointestinal bleeding, and five (0.3%) required major transfusion. CONCLUSIONS: Among patients presenting with septic shock, early treatment with activated protein C may be associated with reduced hospital mortality. |
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Authors:
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Peter K Lindenauer; Michael B Rothberg; Brian H Nathanson; Penelope S Pekow; Jay S Steingrub |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Critical care medicine Volume: 38 ISSN: 1530-0293 ISO Abbreviation: Crit. Care Med. Publication Date: 2010 Apr |
Date Detail:
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Created Date: 2010-03-25 Completed Date: 2010-04-09 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 1101-7 Citation Subset: AIM; IM |
Affiliation:
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Center for Quality of Care Research, Baystate Medical Center, Springfield, MA, USA. Peter.Lindenauer@bhs.org |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Age Factors Aged Anti-Bacterial Agents / therapeutic use Chi-Square Distribution Cohort Studies Confidence Intervals Female Hospital Mortality Humans Length of Stay Male Middle Aged Multivariate Analysis Odds Ratio Propensity Score Protein C / therapeutic use* Respiration, Artificial Retrospective Studies Sex Factors Shock, Septic / drug therapy*, mortality* Treatment Outcome Vasoconstrictor Agents / therapeutic use |
| Chemical | |
Reg. No./Substance:
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0/Anti-Bacterial Agents; 0/Protein C; 0/Vasoconstrictor Agents |
| Comments/Corrections | |
Comment In:
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Crit Care Med. 2010 Apr;38(4):1217-20
[PMID:
20335704
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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