Plasma protein C levels in immunocompromised septic patients are significantly lower than immunocompetent septic patients: a prospective cohort study.
BACKGROUND
Activated Protein C [APC] improves outcome in immunocompetent patients with severe sepsis particularly in those who are perceived to have high mortality risk. Before embarking on a trial of APC administration in immunocompromised septic patients, a preliminary study on plasma levels of protein C in this cohort is essential.


OBJECTIVE
To assess serum Protein C concentrations in immunocompromised patients as compared to immunocompetent patients during sepsis, severe sepsis, septic shock and recovery.


METHODS
Prospective cohort study in a tertiary hospital. Patients satisfying inclusion criteria were enrolled after informed consent. Clinical variables were noted with sample collection when patients met criteria for sepsis, severe sepsis, septic shock and recovery. Protein C levels were measured using monoclonal antibody based fluorescence immunoassay.


RESULTS
Thirty one patients participated in this study (22 immunocompromised, 9 immunocompetent). Protein C levels were found to be significantly lower in the immunocompromised group compared to the immunocompetent group, particularly observed in severe sepsis [2.27 (95% CI: 1.63-2.9) vs 4.19 (95% CI: 2.87-5.52) mcg/ml] (p = 0.01) and sepsis [2.59 (95% CI: 1.98-3.21) vs 3.64 (95% CI: 2.83-4.45) mcg/ml] (p = 0.03). SOFA scores were similar in both the groups across sepsis, severe sepsis and septic shock categories. Protein C levels improved significantly in recovery (p = 0.001) irrespective of immune status.


CONCLUSIONS
Protein C levels were significantly lower in immunocompromised patients when compared to immunocompetent patients in severe sepsis and sepsis categories. Our study suggests a plausible role for APC in severely septic immunocompromised patients which need further elucidation.
Intensive Care, Monash Medical Centre, Clayton, VIC 3168, Australia. rakshitpanwar@hotmail.com
Rakshit
R
Panwar
Bala
B
Venkatesh
Peter
P
Kruger
Robert
R
Bird
Devinder
D
Gill
Leo
L
Nunnink
Goce
G
Dimeski
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007121:Immunocompetence / Q000276:immunology; D016867:Immunocompromised Host; D007902:Length of Stay; D008232:Lymphoproliferative Disorders / Q000097:blood / Q000150:complications / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000097:blood / Q000150:complications / Q000276:immunology; D011486:Protein C / Q000032:analysis*; D018805:Sepsis / Q000097:blood* / Q000276:immunology* / Q000534:rehabilitation; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000276:immunology / Q000534:rehabilitation; D055815:Young Adult
D011486:Protein C