Document Detail

Protein C substitution in sepsis-associated purpura fulminans.
MedLine Citation:
PMID:  10921567     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To assess the effect of protein C (PC) substitution on imminent peripheral necroses and overall outcome in patients with sepsis-associated purpura fulminans. DESIGN: Case series. SETTING: Intensive care units of two university hospitals. PATIENTS: A total of 12 patients with purpura fulminans, disseminated intravascular coagulation and imminent peripheral necroses in association with sepsis caused by Neisseria meningitidis (n = 5), Streptococcus pneumoniae (n = 2), Capnocytophaga canimorsus (n = 2), and Staphylococcus aureus (n = 1). In two patients, no pathogens were identified. INTERVENTIONS: Intravenous administration of PC concentrate (100 IU/kg every 6 hrs). In addition, antithrombin III substitution, antimicrobial therapy, hemodynamic support, and mechanical ventilation in all patients and hemodiafiltration in 10 patients. MAIN RESULTS: After the onset of PC, progressive peripheral ischemia was reversed irrespective of the etiology of infection. Laboratory variables reflecting disseminated intravascular coagulation improved rapidly, although the recovery of the platelet count was retarded in the patients who subsequently died. No drug-related adverse events were noted. Amputations were necessary in two patients, and necrotic tips of fingers and toes were macerated in a third. The hospital mortality was 42%. Of the five lethal cases, two were caused by S. pneumoniae, one by N. meningitidis, one by C. canimorsus, and one by an unknown pathogen. CONCLUSIONS: This article provides encouraging results on the use of PC substitution in meningococcal purpura and presents new data on the administration of this drug to patients with septic purpura caused by other bacterial species. By clinical judgment, PC limited the extent of tissue necrosis. The small number of patients does not allow for any conclusions on the potential effect of PC on mortality. A controlled and randomized study with a larger number of patients is needed before any recommendations can be given on the use of PC in sepsis-related purpura fulminans and shock.
E Rintala; M Kauppila; O P Seppälä; L M Voipio-Pulkki; V Pettilä; V Rasi; P Kotilainen
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Critical care medicine     Volume:  28     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2000 Jul 
Date Detail:
Created Date:  2000-08-16     Completed Date:  2000-08-16     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  2373-8     Citation Subset:  AIM; IM    
Department of Medicine, Turku University Central Hospital, Finland.
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MeSH Terms
Anticoagulants / therapeutic use*
Antithrombin III / therapeutic use
C-Reactive Protein / metabolism
Dacarbazine / blood*
Gangrene / surgery
Hospital Mortality
Intensive Care Units
Middle Aged
Neisseria meningitidis*
Protein C / therapeutic use*
Purpura, Schoenlein-Henoch / complications*,  drug therapy
Respiration, Artificial
Sepsis / complications*,  microbiology*
Serine Proteinase Inhibitors / therapeutic use
Streptococcus pneumoniae*
Treatment Outcome
Reg. No./Substance:
0/Anticoagulants; 0/Protein C; 0/Serine Proteinase Inhibitors; 4342-03-4/Dacarbazine; 9000-94-6/Antithrombin III; 9007-41-4/C-Reactive Protein

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