title: Protein C zymogen in severe sepsis: a double-blinded, placebo-controlled, randomized study.
abstract: OBJECTIVE
  To determine whether protein C zymogen (protein C concentrates or human protein C) improves clinically relevant outcomes in adult patients with severe sepsis and septic shock.
  
  
  METHODS
  This is a randomized, double-blind, placebo-controlled, parallel-group trial that from September 2012 to June 2014 enrolled adult patients with severe sepsis or septic shock and high risk of death and of bleeding (e.g., APACHE II greater than 25, extracorporeal membrane oxygenation or disseminated intravascular coagulopathy). All patients completed their follow-up 90 days after randomization and data were analyzed according to the intention-to-treat principle. Follow-up was performed at 30 and 90 days after randomization. The primary endpoint was a composite outcome of prolonged intensive care unit (ICU) stay and/or 30-day mortality. Secondary endpoints included mortality.
  
  
  RESULTS
  The study was stopped early in a situation of futility for the composite outcome of prolonged ICU stay and/or 30-day mortality that was 79 % (15 patients) in the protein C zymogen group and 67 % (12 patients) in the placebo group (p = 0.40) and for a concomitant safety issue: ICU mortality was 79 % (15 patients) in the protein C zymogen group vs 39 % (7 patients) in the placebo group (p = 0.020), and 30-day mortality was 68 vs 39 % (p = 0.072).
  
  
  CONCLUSIONS
  Protein C zymogen did not improve clinically relevant outcomes in severe sepsis and septic shock adult patients. Given its high cost and the potential increase in mortality, the use of this drug in adult patients should be discouraged.
authors.affiliation: IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Pappalardo
authors.affiliation: IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. crivellari.martina@hsr.it.
authors.forename: Martina
authors.identifier: http://orcid.org/0000-0002-5269-3967
authors.initials: M
authors.lastname: Crivellari
authors.affiliation: IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Ambra L
authors.initials: AL
authors.lastname: Di Prima
authors.affiliation: IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.|Städtiches Klinikum Braunschweigh, Braunschweig, Germany.
authors.forename: Nataliya
authors.initials: N
authors.lastname: Agracheva
authors.affiliation: IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.|Institute of Cardiology, Warsaw, Poland.
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Celinska-Spodar
authors.affiliation: IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Rosalba
authors.initials: R
authors.lastname: Lembo
authors.affiliation: IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.|Ospedale di Roccadaspide, Salerno, Italy.
authors.forename: Daiana
authors.initials: D
authors.lastname: Taddeo
authors.affiliation: IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.|Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.affiliation: IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.|Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D004311:Double-Blind Method; D057239:Early Termination of Clinical Trials; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000378:metabolism; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011486:Protein C / Q000008:administration & dosage* / Q000009:adverse effects / Q000378:metabolism; D022142:Secretory Vesicles / Q000378:metabolism; D018805:Sepsis / Q000188:drug therapy* / Q000401:mortality; D012772:Shock, Septic / Q000188:drug therapy / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D011486:Protein C
keywords: Critical care; Intensive care; Mortality; Protein C; Sepsis; Septic shock