Activated Protein C in Treatment of Severe Sepsis – the First Experience in the Czech Republic

Overview

Introduction:
Drotrecogin alpha (activated) a recombinant form of human activated protein C (APC) has been consideredas the first therapeutic intervention reducing all-cause mortality in severe sepsis, however its use in Europe is still limited.The Czech Republic was the first country in Europe, where APC was used in clinical practice. The aim of the study was topresent initial experience with APC therapy in the Czech Republic and to describe a cohort of patients treated with APC in2002.Material and methods: A retrospective, descriptive study based on medical records of all patients having received APC wasconducted. Age, sex, diagnosis, Apache II score at the time of admission,number of failed organs, timing APC therapy (daysafter ICU admission) and clinical outcome were evaluated. Numerical data are presented as mean (SD) or median (25–75 %).Results: A total of 12 patients (M = 8, F = 4) were treated with drotrecogin alpha (activated) during the evaluated period; themean age was 46 (20), median 54 (26–66) years. The mean value of Apache II score was 27 (6.5), median 25 (23–31) points.The number of failed organs before treatment with APC was 3.5 (1), median 4 (2–4). The mean time before drotrecogin alpha(activated)wasadministered was 3 (5),median 1 (1–2) days.Seven patients of 12 survived (58 %), six of them were dischargedfrom hospital.Conclusion: Drotrecogin alpha (activated) is an important part of therapy in selected cases, current experience showingpromising results so far, however more experience and probably more studies are needed to select the right patients whomay benefit from this expensive therapy and also reimbursement issues must be defined. The Czech Society of Anaesthesiologyand Intensive Care Medicine developed its own extended guidelines and recommendations for using this therapyin the Czech Republic.

Key words:
severe sepsis – therapy – activated protein C