Early infusion of recombinant human activated protein C decreases the number of years lost due to premature death

Introduction

Multicentre studies have demonstrated that early infusion of recombinant human activated protein C (rhAPC) improves survival of patients suffering from severe sepsis. The objective of this study was to demonstrate the benefit of early infusion of rhAPC on the number of years lost due to premature death (YLPD).

Methods

This case–control study included 146 patients suffering from severe sepsis admitted to the ICU from January 2003 to December 2006. Patients were divided into three groups based on the initiation time of rhAPC after the diagnosis of severe sepsis: Group I (GI): patients who received rhAPC within the first 24 hours of severe sepsis (n = 53), Group II (GII): patients who received rhAPC after 24 hours from diagnosis of severe sepsis (n = 41), and Group III (GIII): patients with severe sepsis who did not receive rhAPC (n = 52). Dependent variables included age, gender, APACHE II score, and the number of organs with acute failure at the time of admission, YLPD and mortality. Four follow-up time periods were established: Time (T) I: from initiation of infusion to day 4 of infusion of rhAPC, T2: from completion of infusion to day 8, T3: from day 9 to day 30, and T4: from day 30 to the end of the study period (December 2006). Descriptive statistics were performed to identify the variable distribution. Chi-square analysis was used to determine the association between mortality and therapy. The number of YLPD was calculated according to conventional equations.

Results

There were no differences between groups in age and APACHE II score at admission. There were statistical differences in the number of organs in acute failure; GI 2 (1–5), GII 3 (2–5) and GIII 2 (1–4) (median, minimum and maximum) (P = 0.03). At T1, mortality was 7.5% GI, 26.8% GII and 23.1% GIII (P = 0.03), and YLPD were 81.82 years GI, 226.65 years GII and 189.6 years GIII. Within T2, mortality was 4% GI, 23% GII and 7.5% GIII (P = 0.017), and YLPD were 20 years GI, 102.63 years GII and 54.89 years GIII. Within T4, mortality was 28.3% GI, 70.7% GII and 48.1% GIII (P = 0.000), and YLPD were 244 years GI, 529.7 years GII and 369.24 years GIII.

Conclusion

Early infusion of rhAPC improves survival and decreases the YLPD in patients suffering from severe sepsis.