Clinical and laboratory effects of recombinant human activated protein C in the treatment of a patient with sepsis-induced multiple organ failure.
OBJECTIVE
To evaluate clinical and laboratory effects of the administration of recombinant human activated protein C (rhAPC) in the treatment of a 25-year-old patient with septic shock and multiple organ failure secondary to perinephritic abscesses.


METHODS
Intravenous administration of rhAPC-or drotrecogin alfa (activated)-(24 mcg/kg/h) for a total of 80 h as an adjunct to antimicrobial therapy, mechanical ventilation, hemodynamic support, hemodiafiltration and surgical intervention.


RESULTS
The administration of rhAPC was associated with a rapid recovery of the patient's clinical condition reflected by decreasing Sepsis-related Organ Failure Assessment (SOFA) scores. Laboratory parameters monitoring inflammation and coagulopathy improved during the treatment. No drug-related adverse events were noted.


CONCLUSIONS
RhAPC has been observed to have anticoagulant, anti-inflammatory and profibrinolytic properties in vitro and in vivo. This report describes the effects of rhAPC administration on standard laboratory parameters indicating that no single laboratory parameter exists that is capable of monitoring the effects of rhAPC on the coagulation cascade and the clinical course of sepsis. This description of a patient suffering from sepsis-induced multiple organ failure may illustrate a possible beneficial effect of rhAPC on the course of coagulopathy and systemic inflammatory response and provides evidence for rhAPC complementing standard intensive care therapy in severe sepsis.
Brueckmann
Martina
M
1st Department of Medicine, Faculty of Clinical Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany. martina.brueckmann@med.ma.uni-heidelberg.de
Wizenmann
Jan
J
Hoffmann
Ursula
U
Seeger
Markus
M
Bewig
Burkhard
B
D000328:Adult; D000900:Anti-Bacterial Agents; D000925:Anticoagulants / Q000494:pharmacology / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004211:Disseminated Intravascular Coagulation / Q000517:prevention & control*; D004322:Drainage; D004341:Drug Evaluation; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D009102:Multiple Organ Failure / Q000097:blood* / Q000209:etiology; D011183:Postoperative Complications / Q000097:blood / Q000188:drug therapy / Q000209:etiology; D011486:Protein C / Q000494:pharmacology / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000494:pharmacology / Q000627:therapeutic use*; D017703:Retropharyngeal Abscess / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications* / Q000188:drug therapy; D014546:Urinary Catheterization / Q000009:adverse effects; D014552:Urinary Tract Infections / Q000150:complications / Q000188:drug therapy
D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D011486:Protein C; D011994:Recombinant Proteins; C421124:drotrecogin alfa activated