Systemic host responses in severe sepsis analyzed by causative microorganism and treatment effects of drotrecogin alfa (activated)

Clin Infect Dis. 2003 Jul 1;37(1):50-8. doi: 10.1086/375593. Epub 2003 Jun 24.

Abstract

Clinical trials with novel therapeutic agents for severe sepsis have suggested that patients might respond differently depending on causative microorganism. Data from a large, placebo-controlled trial of recombinant human drotrecogin alfa (activated) (DrotAA) were analyzed by type of causative microorganism for treatment-associated differences in mortality, coagulopathy, and inflammatory response. Compared with placebo, mortality rates associated with DrotAA were consistently reduced for each microorganism group (gram-positive bacteria, gram-negative bacteria, mixed bacteria, fungi, other, and unknown microbial etiology), with a stratified relative risk (RR) of 0.80 (95% confidence interval [CI], 0.69-0.94). The greatest reduction in the mortality rate was for Streptococcus pneumoniae infection (RR, 0.56; 95% CI, 0.35-0.88). Levels of coagulation and inflammation biomarkers varied with different pathogens at study entry. Results demonstrate that DrotAA, administered as an adjunct to standard anti-infective therapy, can improve the rate of survival for patients who develop severe sepsis regardless of causative microorganism.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents
  • Anti-Infective Agents / therapeutic use*
  • Bacteria / classification
  • Biomarkers
  • Blood Coagulation / drug effects
  • Double-Blind Method
  • Fungi / classification
  • Humans
  • Inflammation / etiology
  • Prospective Studies
  • Protein C / metabolism
  • Protein C / therapeutic use*
  • Recombinant Proteins / therapeutic use*
  • Sepsis / drug therapy*
  • Sepsis / microbiology
  • Sepsis / mortality
  • Survival Analysis

Substances

  • Anti-Bacterial Agents
  • Anti-Infective Agents
  • Biomarkers
  • Protein C
  • Recombinant Proteins
  • drotrecogin alfa activated