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  • Meeting abstract
  • Open Access

Case report: short time reversible myocardial dysfunction in sepsis treated with drotrecogin alpha

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Critical Care20037 (Suppl 3) :P24

https://doi.org/10.1186/cc2220

  • Published:

Keywords

  • Intensive Care Unit
  • Diabetes Mellitus Type
  • Severe Sepsis
  • Organ Dysfunction
  • Systemic Inflammatory Response Syndrome
Severe sepsis is a complex process that involves a number of host immune responses with an orchestration of various specific and nonspecific soluble factors and cellular elements that may result in a completely different outcome. Among organ dysfunction induced by sepsis, heart failure can occur in up to 40% of cases [1]. Myocardial depression in shock probably was first described in 1947 [2]. Its onset may be extremely early, but is most evident in the first 3 days of the disease. Normalization usually happens over the following 7-10 days in the survivor patients [3]. We have described an atypical sort time reversible myocardial dysfunction, in a patient with rapid evolution to a multiple organ dysfunction syndrome (heart, renal, pulmonary, and hematological). An 87-year-old man with hypertension and diabetes mellitus type 2 was admitted to our intensive care unit (ICU) with severe sepsis caused by community-acquired pneumonia. On the following day of his ICU entrance he developed septic shock which was associated with an increase in the cardiac enzymes, particularly troponin I and CK mass (fluorogen immunoassay). We started the infusion of Xigris®, a recombinant version of human activated protein C, according to the PROWESS [4] protocol. His baseline examination characteristics before and 3 days after Xigris® infusion are summarized in Table 1.

Table 1

Characteristic

Admission

Pre-Xigris® infusion

3 days after end-infusion

Troponin I (ng/ml) < 0.4

1.1

1.6

Normal

CPK MB mass (ng/ml) < 5

6.2

9.5

Normal

C-reactive protein (mg/dl) < 1

36.3

38.7

3.6

Antithrombin (%)

64

54

89

Protein C (%)

62

48

100

D-dimer (mg/ml) < 0.5

2.15

2.34

3.28

Thrombocytes

98.000

81.000

233.000

B-type natriuretic peptide (pg/ml)

> 1300

 

1170

Vasopressor therapy

+/++++

++++/++++

None

Mechanical ventilation

None

++++/++++

Weaning

Echo dysfunction

+/++++

++++/++++

+/++++

The patient was discharged 10 days after the Xigris® end-of-infusion to a step-down unit. The physiology of the myocardial dysfunction that occurs in systemic inflammatory response syndrome is not well understood, although there are several theories to explain it [58]. We are reporting an unusual behavior of reversible nonischemic myocardial dysfunction possibly related to Xigris® treatment. Perhaps this communication could be tested in a well-designed study to address a new hypothesis for new applications of activated protein C outside the setting of severe sepsis.

Authors’ Affiliations

(1)
Hospital Pró-Cardíaco, Rio de Janeiro, RJ, Brazil

References

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