Drotrecogin alfa (activated): a single-centre experience of 110 patients

Introduction

We present our experience with drotrecogin alfa (activated protein C (APC)) over 4 years (2005 to 2008) in 110 patients and compare the findings with a large UK audit [1].

Methods

Data were collected on diagnosis, acuity, complications and outcomes. Survival was assessed using standardised mortality ratios.

Results

One hundred and ten patients received APC. Two patients had two courses. Fifty-six per cent of patients received APC in the first 24 hours of ICU stay; 88% within 48 hours. Sixty-eight per cent of patients completed the 96-hour course; 20% died during the infusion; 5% had APC stopped because of resolution of severe sepsis. Crude ICU mortality was 47%; 9% died after ICU discharge. Survival to hospital discharge was 44%. The SMRs were 1.21 (95% CI 1.02 to 1.41) using APACHE II and 1.05 (0.88 to 1.22) using the ICNARC method. Three patients had cerebral haemorrhage. Three had cerebral thrombotic events. There were no other cases of significant haemorrhage. APC usage fell over the study period 2005 to 2008 with 37, 35, 26 and 14 patients per year, respectively.

Conclusions

Our results are similar to those of a UK-wide audit of APC usage [1]. The mortality of our patients was higher (56% vs 45%), but our patients were probably sicker (median five organ failures vs three). Based on APACHE, actual outcome appears worse than predicted for patients receiving APC. Using the ICNARC method score, however, outcomes were similar to predicted. Rates of serious complications appeared to be similar to those experienced elsewhere. The fall in APC usage over time reflects uncertainty over its risk-benefit profile.

Table 1 Patient characteristics