Recombinant Human Activated Protein C Reduces Mortality of Severe Sepsis-Related ARDS

Abstract

Introduction: We attempted to investigate the prognosis of severe sepsis-related acute respiratory distress syndrome (ARDS) in adult patients admitted to intensive care units (ICUs) at a medical center in southern Taiwan, especially focusing on the efficacy of recombinant human activated protein C (rhAPC), which is still rarely highlighted in such patients. Methods: From January 2004 to June 2006, we performed a retrospective, observational cohort study to investigate the impact of rhAPC on the prognosis of ARDS patients with mechanical ventilation, who met the criteria of the American-European Consensus Conference (AECC) definition of ARDS, and who had the presence of sepsis with high acute physiology and chronic health evaluation Ⅱ (APAC HE Ⅱ) score of ≥25 and multiple organ failure. Results: Over a 30-month period, a total of 64 patients were enrolled. The incidence of sepsis-related ARDS was 0.7% of 9473 ICU admissions with mechanical ventilation and an APACHE Ⅱ of 29.3 ± 4.7 at inclusion. The hospital mortality rate was 67.2%. The rhAPC-treated group had similar demographic and clinical data except a significantly lower rate of 28-day and hospital mortality (37.5% vs. 66.7% and 43.8% vs. 75%, respectively), but also a higher total hospital cost (USD23, 851 vs. USD11, 376) compared with the non-rhAPC group. Using multivariate analyses, rhAPC infusion was shown to significantly influence the mortality of sepsis-related ARDS. Conclusion: Severe sepsis-related ARDS possessed a high hospital mortality rate. Prompt initiation of rhAPC infusion may significantly reduce the mortality rate in these severely ill patients regardless of higher hospital expenditure.