Abstract
Activated protein C (APC) is an effective treatment in multiorgan failure (MOF) due to severe sepsis. Recommended duration of treatment of APC is 96 hours infusion. The cost of APC infusion for 96 hours in a 60 kg person is an average INR 490,000 in India (€7,000) (€1 ~ INR 70 in November 2009, average value) whereas the average cost of 10 days of ICU treatment for a patient with sepsis with MOF, all inclusive, is approximately INR 140,000 in our hospital (€2,000). It is unclear whether stopping APC before 96 hours, in patients in whom MOF resolves before 96 hours, ultimately affects the final outcome in terms of survival. This is more relevant in developing countries like India where the cost of 96 hours of infusion of APC is beyond the reach of the majority of patients eligible for it. We retrospectively analysed the cost savings achieved by early stoppage of APC ensuring MOF reversal, before completion of the recommended 96 hours infusion.
Highlights
We previously showed that erythropoietin (EPO) attenuates the morphological signs of spinal cord ischemia/reperfusion (I/R) injury in swine [1] without, improving neurological function
The clinical use of EPO has been cautioned most recently due to serious safety concerns arising from an increased mortality in acute stroke patients treated with EPO and simultaneously receiving systemic thrombolysis [2]
Sodium 4-phenylbutyrate (PBA) has been reported to act as a chemical chaperone inhibiting Unfolded protein response (UPR)-mediated apoptosis triggered by ischemia in various organs other than the heart
Summary
We previously showed that erythropoietin (EPO) attenuates the morphological signs of spinal cord ischemia/reperfusion (I/R) injury in swine [1] without, improving neurological function. Methods We studied 90 patients affected by severe sepsis or septic shock previously enrolled in a prospective trial regarding the impact of glycemic control on inflammation and coagulation. In a retrospective analysis of the data from the SBITS-trial [1] we investigated whether the initial level of serum IgG on admission to the hospital in patients with sepsis and septic shock (before the first administration of the first dose of intravenous immunoglobulins) could be seen as a prognostic parameter for the primary outcome, lethality on day 28, or the secondary endpoints, lethality on day 7 or on the ICU. The aim of this analysis was to assess the impact of real-time continuous glucose monitoring (CGM) on glucose variability in critically ill patients receiving intensive insulin therapy (IIT) Methods This is the post hoc analysis of a prospective, randomized, controlled trial [2]. Respecting anonymity we have statistically evaluated 103 replies (response rate was 13.8%) and compared with data from other European countries
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