Predictors of hospital mortality for patients with severe sepsis treated with Drotrecogin alfa (activated).
OBJECTIVE
To identify predictors of hospital mortality among patients with severe sepsis who were treated with drotrecogin alfa (activated).


METHODS
Prospective observational cohort study.


METHODS
A 1400-bed academic medical center.


METHODS
One hundred two patients treated with drotrecogin alfa (activated) for severe sepsis.


RESULTS
To identify potential risk factors for hospital mortality, the main outcome evaluated, all patients who received drotrecogin alfa (activated) were segregated according to hospital survival. The following characteristics were recorded: age, sex, weight, surgical or nonsurgical, Acute Physiology and Chronic Health Evaluation (APACHE) II score, number of acquired organ-system derangements, mechanical ventilation, use of vasopressors or dobutamine, patient location 24 hours before receiving drotrecogin alfa (activated), source of infection, microbiologically positive culture, and other process-of-care variables. Of the 102 patients, 43 (42.2%) died during their hospitalization. Potential predictors of hospital mortality identified by univariate analysis included greater APACHE II scores, administration of vasopressin or dobutamine, number of acquired organ-system derangements, time to treatment with drotrecogin alfa (activated), intravenous fluid administered before receiving vasopressors or drotrecogin alfa (activated), number of red blood cell transfusions, and administration of inappropriate initial antimicrobial treatment. Multivariate analysis revealed that vasopressin administration (odds ratio [OR] 3.72, 95% confidence interval [CI] 1.95-7.10), number of acquired organ-system derangements (OR 2.30, 95% CI 1.59-3.31), and administration of inappropriate initial antimicrobial treatment (OR 15.5, 95% CI 6.78-35.6) were independently associated with hospital mortality.


CONCLUSIONS
Number of acquired organ-system derangements, vasopressin administration, and treatment with an inappropriate initial antimicrobial regimen are independently associated with an increased risk of hospital mortality among patients treated with drotrecogin alfa (activated) for severe sepsis. These findings suggest that other specific medical interventions may increase survival in this patient population.
Micek
Scott T
ST
Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, Missouri, USA.
Isakow
Warren
W
Shannon
William
W
Kollef
Marin H
MH
D005767:Gastrointestinal Diseases / Q000453:epidemiology / Q000382:microbiology; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients; D007362:Intensive Care Units; D008171:Lung Diseases / Q000453:epidemiology / Q000382:microbiology; D008875:Middle Aged; D011446:Prospective Studies; D011486:Protein C / Q000008:administration & dosage / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use*; D012307:Risk Factors; D018805:Sepsis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D012720:Severity of Illness Index; D017192:Skin Diseases, Bacterial / Q000453:epidemiology / Q000382:microbiology; D018461:Soft Tissue Infections / Q000453:epidemiology / Q000382:microbiology; D014667:Vasopressins / Q000008:administration & dosage / Q000009:adverse effects
D011486:Protein C; D011994:Recombinant Proteins; D014667:Vasopressins; C421124:drotrecogin alfa activated