STUDY OBJECTIVE: To identify predictors of hospital mortality among patients with severe sepsis who were treated with drotrecogin alfa (activated). DESIGN: Prospective observational cohort study. SETTING: A 1400-bed academic medical center. PATIENTS: One hundred two patients treated with drotrecogin alfa (activated) for severe sepsis. MEASUREMENTS AND MAIN 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. CONCLUSION: 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.
STUDY OBJECTIVE: To identify predictors of hospital mortality among patients with severe sepsis who were treated with drotrecogin alfa (activated). DESIGN: Prospective observational cohort study. SETTING: A 1400-bed academic medical center. PATIENTS: One hundred two patients treated with drotrecogin alfa (activated) for severe sepsis. MEASUREMENTS AND MAIN 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. CONCLUSION: 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.
Authors: Scott T Micek; Emily C Welch; Junaid Khan; Mubashir Pervez; Joshua A Doherty; Richard M Reichley; Marin H Kollef Journal: Antimicrob Agents Chemother Date: 2010-02-16 Impact factor: 5.191
Authors: Frank Bloos; Frank Hinder; Karsten Becker; Svea Sachse; Armand Mekontso Dessap; Eberhard Straube; Vincent Cattoir; Christian Brun-Buisson; Konrad Reinhart; Georg Peters; Michael Bauer Journal: Intensive Care Med Date: 2009-11-19 Impact factor: 17.440
Authors: Frank Bloos; Svea Sachse; Andreas Kortgen; Mathias W Pletz; Marc Lehmann; Eberhard Straube; Niels C Riedemann; Konrad Reinhart; Michael Bauer Journal: PLoS One Date: 2012-09-27 Impact factor: 3.240