Human protein C zymogen concentrate in patients with severe sepsis and multiple organ failure after adult cardiac surgery.
OBJECTIVE
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 < or = 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.
Crivellari
Martina
M
Department of Cardiac Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Via Olgettina 60 Milano, Milan, 20132, Italy.
Della Valle
Patrizia
P
Landoni
Giovanni
G
Pappalardo
Federico
F
Gerli
Chiara
C
Bignami
Elena
E
Marino
Giovanni
G
Zangrillo
Alberto
A
D'Angelo
Armando
A
D000368:Aged; D000990:Antithrombin III / Q000187:drug effects; D000991:Antithrombins / Q000187:drug effects / Q000378:metabolism; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005343:Fibrinolytic Agents / Q000378:metabolism / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D007378:Interleukins / Q000097:blood; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D010314:Partial Thromboplastin Time; D010447:Peptide Hydrolases / Q000097:blood / Q000187:drug effects; D010865:Pilot Projects; D011182:Postoperative Care; D011486:Protein C / Q000378:metabolism / Q000627:therapeutic use*; D011517:Prothrombin Time; D018805:Sepsis / Q000097:blood / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
D000991:Antithrombins; D005343:Fibrinolytic Agents; D007378:Interleukins; D011486:Protein C; C046193:antithrombin III-protease complex; D000990:Antithrombin III; D010447:Peptide Hydrolases