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Báo cáo khoa học: "Recombinant activated protein C: the key is clinical assessment of risk of death, not subset analysis"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Recombinant activated protein C: the key is clinical assessment of risk of death, not subset analysis. | Available online http ccforum.eom content 10 1 114 Commentary Recombinant activated protein C the key is clinical assessment of risk of death not subset analysis R Phillip Dellinger Director Section of Critical Care Medicine Cooper University Hospital One Cooper Plaza Camden NJ 08103 USA Correspondence R Phillip Dellinger dellinger-phil@cooperhealth.edu Published 30 January 2006 This article is online at http ccforum.com content 10 1 114 2006 BioMed Central Ltd Critical Care 2006 10 114 doi 10.1186 cc3991 Abstract The PROWESS Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis trial demonstrated a 6.1 absolute decrease in mortality with a p value of 0.005. Despite the impressive results of this trial criticism of the study has targeted various aspects of design analysis and interpretation. Additional studies of recombinant activated protein C rhAPC have added to our understanding about this drug and to controversy as well. So how do we deal with rhAPC use in our clinical practice The PROWESS Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis trial demonstrated a 6.1 absolute decrease in mortality with a p value of 0.005 1 . Recombinant activated protein C rhAPC was approved by the FDA for use in patients with sepsis induced organ dysfunction associated with a high risk of death such as an APACHE Acute Physiology and Chronic Health Evaluation II of 25 . APACHE II 25 was used as one marker of high risk of death because a subset data analysis demonstrated that the treatment benefit in the PROWESS trial was predominantly in this group of patients. The European regulatory body approved rhAPC for multiple organ failure again based on subset data analysis from the PROWESS trial demonstrating increased treatment effect as the number of organ failures increased . The Surviving Sepsis Campaign SSC Guidelines for the Management of Severe Sepsis and Septic Shock recommend the use of rhAPC in patients with high risk of death due