Human protein C zymogen concentrate in patients with severe sepsis and multiple organ failure after adult cardiac surgery

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Abstract

Purpose: To describe outcome and changes in clotting and inflammatory parameters in an uncontrolled case series of consecutive patients with severe sepsis who received protein C concentrate soon after cardiac surgery. Methods: From January 2007 to January 2008 nine consecutive adult patients with severe sepsis or septic shock and two or more organ failure after cardiac surgery received protein C concentrate, 50 IU/kg as a bolus followed by continuous infusion of 3 IU/kg per hour for 72 h. Results: The increase in protein C levels was accompanied by an early drop in interleukins and near-normalization of prothrombin time, activated partial thromboplastin time, antithrombin and thrombin-antithrombin complex levels (p ≤ 0.03). No patient experienced drug-related side effects. Thirty-day mortality was 11% (1 patient) compared to the expected mortality of 68%. Conclusions: In this pilot, uncontrolled study of nine patients with sepsis-induced double organ failure following cardiac surgery, treatment with protein C concentrate was associated with significant improvement in clinical, inflammatory and clotting parameters, no bleeding and low 30-day mortality.

Original languageEnglish
Pages (from-to)1959-1963
Number of pages5
JournalIntensive Care Medicine
Volume35
Issue number11
DOIs
Publication statusPublished - Nov 2009

Fingerprint

Enzyme Precursors
Multiple Organ Failure
Protein C
Thoracic Surgery
Sepsis
Mortality
Antithrombins
Partial Thromboplastin Time
Interleukins
Prothrombin Time
Septic Shock
Drug-Related Side Effects and Adverse Reactions
Hemorrhage

Keywords

  • Bleeding
  • Cardiac surgery
  • Critically ill
  • Organ failure
  • Protein C concentrate
  • Septic shock

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

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title = "Human protein C zymogen concentrate in patients with severe sepsis and multiple organ failure after adult cardiac surgery",
abstract = "Purpose: To describe outcome and changes in clotting and inflammatory parameters in an uncontrolled case series of consecutive patients with severe sepsis who received protein C concentrate soon after cardiac surgery. Methods: From January 2007 to January 2008 nine consecutive adult patients with severe sepsis or septic shock and two or more organ failure after cardiac surgery received protein C concentrate, 50 IU/kg as a bolus followed by continuous infusion of 3 IU/kg per hour for 72 h. Results: The increase in protein C levels was accompanied by an early drop in interleukins and near-normalization of prothrombin time, activated partial thromboplastin time, antithrombin and thrombin-antithrombin complex levels (p ≤ 0.03). No patient experienced drug-related side effects. Thirty-day mortality was 11{\%} (1 patient) compared to the expected mortality of 68{\%}. Conclusions: In this pilot, uncontrolled study of nine patients with sepsis-induced double organ failure following cardiac surgery, treatment with protein C concentrate was associated with significant improvement in clinical, inflammatory and clotting parameters, no bleeding and low 30-day mortality.",
keywords = "Bleeding, Cardiac surgery, Critically ill, Organ failure, Protein C concentrate, Septic shock",
author = "Martina Crivellari and Valle, {Patrizia Della} and Giovanni Landoni and Federico Pappalardo and Chiara Gerli and Elena Bignami and Giovanni Marino and Alberto Zangrillo and Armando D'Angelo",
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T1 - Human protein C zymogen concentrate in patients with severe sepsis and multiple organ failure after adult cardiac surgery

AU - Crivellari, Martina

AU - Valle, Patrizia Della

AU - Landoni, Giovanni

AU - Pappalardo, Federico

AU - Gerli, Chiara

AU - Bignami, Elena

AU - Marino, Giovanni

AU - Zangrillo, Alberto

AU - D'Angelo, Armando

PY - 2009/11

Y1 - 2009/11

N2 - Purpose: To describe outcome and changes in clotting and inflammatory parameters in an uncontrolled case series of consecutive patients with severe sepsis who received protein C concentrate soon after cardiac surgery. Methods: From January 2007 to January 2008 nine consecutive adult patients with severe sepsis or septic shock and two or more organ failure after cardiac surgery received protein C concentrate, 50 IU/kg as a bolus followed by continuous infusion of 3 IU/kg per hour for 72 h. Results: The increase in protein C levels was accompanied by an early drop in interleukins and near-normalization of prothrombin time, activated partial thromboplastin time, antithrombin and thrombin-antithrombin complex levels (p ≤ 0.03). No patient experienced drug-related side effects. Thirty-day mortality was 11% (1 patient) compared to the expected mortality of 68%. Conclusions: In this pilot, uncontrolled study of nine patients with sepsis-induced double organ failure following cardiac surgery, treatment with protein C concentrate was associated with significant improvement in clinical, inflammatory and clotting parameters, no bleeding and low 30-day mortality.

AB - Purpose: To describe outcome and changes in clotting and inflammatory parameters in an uncontrolled case series of consecutive patients with severe sepsis who received protein C concentrate soon after cardiac surgery. Methods: From January 2007 to January 2008 nine consecutive adult patients with severe sepsis or septic shock and two or more organ failure after cardiac surgery received protein C concentrate, 50 IU/kg as a bolus followed by continuous infusion of 3 IU/kg per hour for 72 h. Results: The increase in protein C levels was accompanied by an early drop in interleukins and near-normalization of prothrombin time, activated partial thromboplastin time, antithrombin and thrombin-antithrombin complex levels (p ≤ 0.03). No patient experienced drug-related side effects. Thirty-day mortality was 11% (1 patient) compared to the expected mortality of 68%. Conclusions: In this pilot, uncontrolled study of nine patients with sepsis-induced double organ failure following cardiac surgery, treatment with protein C concentrate was associated with significant improvement in clinical, inflammatory and clotting parameters, no bleeding and low 30-day mortality.

KW - Bleeding

KW - Cardiac surgery

KW - Critically ill

KW - Organ failure

KW - Protein C concentrate

KW - Septic shock

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