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首页> 外文期刊>Critical care medicine >Evaluating the use of recombinant human activated protein C in adult severe sepsis: Results of the Surviving Sepsis Campaign
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Evaluating the use of recombinant human activated protein C in adult severe sepsis: Results of the Surviving Sepsis Campaign

机译：评估重组人激活蛋白C在成人严重脓毒症中的使用：败血症生存运动的结果

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Objective: The Surviving Sepsis Campaign developed guidelines for the administration of recombinant human activated protein C in adult severe sepsis. However, it is not clear how these impacted clinical practice or patient outcome. Design and Setting: The Surviving Sepsis Campaign has developed an extensive database to assess the efficacy of the overall effect of its guidelines on clinical practice and patient outcome. From data submitted to the Surviving Sepsis Campaign database from January 2005 through March 2008, we evaluated data regarding the administration of recombinant human activated protein C in adult severe sepsis. Subjects: Data from 15,022 subjects at 165 sites were analyzed. Measurements and Main Results: Of patients with severe sepsis in the database, 1,009 of 15,022 (8%) received recombinant human activated protein C. Recombinant human activated protein C was administered within 24 hrs of the onset of sepsis in 76% (771 of 1009) of patients. Patients in North America (7.1%) and Europe (6.8%) were more likely to receive recombinant human activated protein C than patients in South America (4.2%, p < .001). After adjusting for covariates, the group that received recombinant human activated protein C had a significantly reduced associated hospital mortality (odds ratio 0.76, 95% confidence interval 0.66-0.86, p < .001). Comparing all the patients who received recombinant human activated protein C to those who did not receive recombinant human activated protein C, the reduction in the adjusted hospital mortality was only statistically significant in patients who had multiorgan dysfunction (odds ratio 0.82, 95% confidence interval 0.69-0.98, p = .027) vs. those who only had single organ dysfunction (odds ratio 0.78, 95% confidence interval 0.59-1.02, p = .072). However, in patients who received recombinant human activated protein C before 24 hrs there was a reduction in adjusted hospital mortality in patients with only one organ dysfunction (odds ratio 0.70, 95% confidence interval 0.51-0.9, p = .03) as well as patients with multiorgan dysfunction (odds ratio 0.78, 95% confidence interval 0.64-0.94 p = .012). There was a statistically significant increase over time in the percentage compliance with the institution of a recombinant human activated protein C administration policy from the first, second, and eighth quarters (47.4%, 46.2%, and 60.7%, respectively) (p < .001). There was also a statistically significant increase in the actual administration rates of recombinant human activated protein C over the same timeline (p < .001), with administration rates of recombinant human activated protein C reaching 9.2% in the last quarter. Conclusions: Recombinant human activated protein C use was associated with a significant improvement in hospital mortality in patients who participated in the Surviving Sepsis Campaign.
机译：目的：存活脓毒症运动制定了成人成年严重脓毒症患者重组人激活蛋白C给药指南。但是，尚不清楚这些因素如何影响临床实践或患者预后。设计与设置：脓毒症生存运动已开发了一个广泛的数据库，以评估其指南对临床实践和患者预后的总体效果。从2005年1月至2008年3月提交至存活脓毒症运动数据库的数据，我们评估了在成人严重脓毒症中施用重组人活化蛋白C的数据。受试者：分析了来自165个站点的15,022名受试者的数据。测量和主要结果：在数据库中有严重脓毒症的患者中，15,022名中的1,009名（8％）接受了重组人激活蛋白C的治疗。败血症发作后24小时内，重组人激活蛋白C的使用率为76％（1009中的771） ）的患者。与南美地区的患者相比，北美地区的患者（7.1％）和欧洲地区的患者（6.8％）接受重组人激活蛋白C的可能性更高（4.2％，p <.001）。调整协变量后，接受重组人激活蛋白C的组的相关医院死亡率显着降低（赔率0.76，95％置信区间0.66-0.86，p <.001）。将所有接受重组人激活蛋白C的患者与未接受重组人激活蛋白C的患者进行比较，调整后的医院死亡率仅在具有多器官功能障碍的患者中具有统计学意义（优势比为0.82，95％置信区间为0.69） -0.98，p = .027）与仅患有单一器官功能障碍的患者（赔率0.78，95％置信区间0.59-1.02，p = .072）相比。然而，在24小时之前接受重组人活化蛋白C的患者中，只有一种器官功能障碍（赔率比0.70，95％置信区间0.51-0.9，p = .03）的患者经调整的住院死亡率降低，并且多器官功能不全的患者（赔率0.78，95％置信区间0.64-0.94 p = 0.012）。从第一季度，第二季度和第八季度开始，重组人激活的蛋白C施用政策的实施依从性百分比随时间的推移在统计上显着增加（分别为47.4％，46.2％和60.7％）（p <。 001）。与同一时间轴相比，重组人活化蛋白C的实际给药率在统计学上也有显着增加（p <.001），重组人活化蛋白C的给药率在最后一个季度达到9.2％。结论：重组人激活蛋白C的使用与幸存脓毒症患者的住院死亡率显着改善有关。

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