Randomized clinical trial of activated protein C for the treatment of acute lung injury
KD Liu, J Levitt, H Zhuo, RH Kallet, S Brady… - American journal of …, 2008 - atsjournals.org
KD Liu, J Levitt, H Zhuo, RH Kallet, S Brady, J Steingrub, M Tidswell, MD Siegel, G Soto…
American journal of respiratory and critical care medicine, 2008•atsjournals.orgRationale: Microvascular injury, inflammation, and coagulation play critical roles in the
pathogenesis of acute lung injury (ALI). Plasma protein C levels are decreased in patients
with acute lung injury and are associated with higher mortality and fewer ventilator-free
days. Objectives: To test the efficacy of activated protein C (APC) as a therapy for patients
with ALI. Methods: Eligible subjects were critically ill patients who met the
American/European consensus criteria for ALI. Patients with severe sepsis and an APACHE …
pathogenesis of acute lung injury (ALI). Plasma protein C levels are decreased in patients
with acute lung injury and are associated with higher mortality and fewer ventilator-free
days. Objectives: To test the efficacy of activated protein C (APC) as a therapy for patients
with ALI. Methods: Eligible subjects were critically ill patients who met the
American/European consensus criteria for ALI. Patients with severe sepsis and an APACHE …
Rationale: Microvascular injury, inflammation, and coagulation play critical roles in the pathogenesis of acute lung injury (ALI). Plasma protein C levels are decreased in patients with acute lung injury and are associated with higher mortality and fewer ventilator-free days.
Objectives: To test the efficacy of activated protein C (APC) as a therapy for patients with ALI.
Methods: Eligible subjects were critically ill patients who met the American/European consensus criteria for ALI. Patients with severe sepsis and an APACHE II score of 25 or more were excluded. Participants were randomized to receive APC (24 μg/kg/h for 96 h) or placebo in a double-blind fashion within 72 hours of the onset of ALI. The primary endpoint was ventilator-free days.
Measurements and Main Results: APC increased plasma protein C levels (P = 0.002) and decreased pulmonary dead space fraction (P = 0.02). However, there was no statistically significant difference between patients receiving placebo (n = 38) or APC (n = 37) in the number of ventilator-free days (median [25–75% interquartile range]: 19 [0–24] vs. 19 [14–22], respectively; P = 0.78) or in 60-day mortality (5/38 vs. 5/37 patients, respectively; P = 1.0). There were no differences in the number of bleeding events between the two groups.
Conclusions: APC did not improve outcomes from ALI. The results of this trial do not support a large clinical trial of APC for ALI in the absence of severe sepsis and high disease severity.
Clinical trial registered with www.clinicaltrials.gov (NCT 00112164).
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