Drotrecogin alfa in sepsis: analysis of outcomes in a UK district general intensive care unit

Introduction

The PROWESS [1] study reported a 6.1% reduction in risk of death at 28 days with Drotrecogin alfa use. We wished to review the hospital mortality of all critically ill patients treated within 48 hours of two organ failures with Drotrecogin alfa since its introduction into our clinical practice. We therefore undertook a prospective case-controlled study.

Method

Fifteen patients who received Drotrecogin alfa were each matched for ICNARC diagnostic category and APACHE II score with two historical controls. These were selected from patients admitted prior to the availability of Drotrecogin alfa. Following successful matching, the mortality was unblinded.

Results

The two groups (control and Drotrecogin alfa) had comparable APACHE II scores (25.5 vs 25.7) and risk of death at admission (0.52 vs 0.54), respectively [2]. The mortality was 60% for historical controls and 27% for those receiving Drotrecogin alfa. The standardised mortality ratios were 1.14 and 0.49, respectively (chi-squared P < 0.05).

Conclusion

Protocol-driven Drotrecogin alfa treatment in septic patients appears to confer a survival benefit in a UK district general intensive care unit. The absolute mortality reduction of 33% was considerably higher than that in PROWESS [1].

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