原创力文档protein c concentrations in severe sepsis an early directional change in plasma levels predicts outcome蛋白c浓度严重脓毒症早期定向改变等离子体水平预测的结果.pdfVIP
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protein c concentrations in severe sepsis an early directional change in plasma levels predicts outcome蛋白c浓度严重脓毒症早期定向改变等离子体水平预测的结果
Shorr et al. Critical Care 2006, 10:R92
/content/10/3/R92
RESEARCH Open Access
Protein C concentrations in severe sepsis:
an early directional change in plasma levels
predicts outcome
1* 2 3 4 5
Andrew F Shorr , Gordon R Bernard , Jean-Francois Dhainaut , James R Russell , William L Macias ,
David R Nelson5 and David P Sundin5
See related commentary by Timsit: /content/10/4/157
Abstract
Introduction: Protein C, because of its central role in hemostasis, plays an integral role in the host response to
infection. Protein C depletion, resulting from increased consumption, degradation, and/or decreased synthesis, is
characteristic of sepsis and has been shown to predict morbidity and mortality. The objective of this study was to
determine whether early directional changes in protein C levels correlate with outcome.
Methods: Patients in the Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis
(PROWESS) clinical trial were assessed and categorized by baseline protein C (n = 1574). Deficiency was categorized
as: severe deficiency, protein C levels ≤ 40% of normal protein C activity (n = 615, 39% of patients); deficient,
protein C levels 41–80% of normal protein C activity (n = 764, 48.5% of patients); and normal, 80% of normal
protein C activity (n = 195, 12.4% of patients). Logistic regression analysis of 28-day mortality for placebo patients
was used to investigate whether baseline and day 1 protein C levels were independent risk factors for mortality.
The impact of treatment with drotrecogin alfa (activated) (DrotAA) was also assessed.
Results: Protein C levels at baseline and day 1 were independent risk factors in placebo patients. If baseline protein C
levels of severely
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