title: Severe protein C deficiency is associated with organ dysfunction in patients with severe sepsis.
abstract: OBJECTIVE
  The aim of this study was to assess the relationship between protein C levels and temporal changes in organ dysfunction.
  
  
  METHODS
  Using data from the placebo arm of Recombinant Human Activated PROtein C Worldwide Evaluation in Severe Sepsis trial (N = 775), we compared the development of organ dysfunction over time, in adult severe sepsis patients with and without severe protein C deficiency.
  
  
  RESULTS
  At study enrollment (baseline), patients with and without severe protein C deficiency were similar in age and likelihood of comorbidities. Patients with severe protein C deficiency had lower arterial blood pressure (P = .0006), greater serum creatinine concentration (P < .0001), elevated markers of thrombosis and inflammation, and impairment of fibrinolysis (P < .0001). The baseline PaO(2)/FiO(2) ratio was not significantly different between the 2 groups. Seven days after study enrollment, cardiovascular and renal function remained significantly worse in patients with severe protein C deficiency (P < .0001), and respiratory dysfunction was greater (P < .0001). Baseline protein C deficiency was seen to be associated with subsequent pulmonary, renal, and hematologic organ failure.
  
  
  CONCLUSIONS
  Severe protein C deficiency in patients with severe sepsis is associated with both the incidence and severity of organ dysfunction and subsequent worsening of organ function and may be a useful predictor of organ failure in severe sepsis.
authors: Department of Anesthesiology, Duke University, DUMC 3094, Durham, NC 27710, USA. andrew.shaw@duke.edu
authors: Andrew D
authors: AD
authors: Shaw
authors: George M
authors: GM
authors: Vail
authors: Douglas J
authors: DJ
authors: Haney
authors: Jin
authors: J
authors: Xie
authors: Mark D
authors: MD
authors: Williams
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001774:Blood Chemical Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D011486:Protein C / Q000032:analysis; D020151:Protein C Deficiency / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D018805:Sepsis / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D011486:Protein C