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Published on: May 7, 2011
[Protein C concentrate in the treatment of severe sepsis in the pediatric setting]
R Ramos Guerrero1, J D López Castilla, M Atienza Fernández
1Servicio de Farmacia. Hospital Universitario Virgen del Rocío. Sevilla. Spain. rramosguerrero@navegalia.com
Insights
Severe sepsis in children can cause protein C deficiency. Protein C concentrate may improve coagulation, but more trials are needed to confirm its effectiveness and safety in pediatric patients.
Area of Science:
- Pediatric critical care medicine
- Hematology
- Pharmacology
Background:
- Severe sepsis can lead to acquired protein C deficiency, correlating with poor clinical outcomes.
- Protein C replacement therapy is a potential strategy, but its use in pediatric severe sepsis is not established.
- Available protein C products (concentrated and activated) lack registration for pediatric severe sepsis treatment.
Observation:
- This study explored the use of protein C concentrate as an adjuvant therapy in three pediatric patients with severe sepsis.
- The study was conducted in a Pediatric Intensive Care Unit setting.
- Limited prior experience exists regarding protein C use in this specific pediatric population.
Findings:
- In all three cases, elevated protein C levels were associated with normalized coagulation parameters and decreased D-dimer levels.
- Two of the three pediatric patients experienced favorable outcomes after protein C concentrate treatment.
- One patient succumbed to septic shock and multiple organ dysfunction despite treatment.
Implications:
- Protein C concentrate shows potential as an adjunctive treatment for severe sepsis in children, improving coagulation markers.
- Further clinical trials are essential to validate the efficacy and safety of protein C concentrate in pediatric severe sepsis.
- Elucidating the optimal role and type of protein C for managing pediatric severe sepsis requires dedicated research.
Abstract:
Patients with severe sepsis develop acquired protein C deficiency, and the extent of such deficiency and negative clinical outcomes correlate. Replacing this protein may help prevent such a condition. Two protein C types are commercially available - concentrated and activated proteins. None is registered for the treatment of severe sepsis in the pediatric setting. Experience with protein C in this group of conditions is limited. Appropriate clinical trials are required to establish effectiveness and safety, and to elucidate the role of either protein C type in the management of this condition in the pediatric setting. This paper discusses experience with the use of protein C concentrate as an adjuvant treatment in addition to conventional therapy in three children with severe sepsis at a Pediatric Intensive Care Unit. In all 3 cases of our study, high levels of protein C correlated to coagulation parameter normalization and reduced dimer D levels. Two out of three had a favorable outcome following treatment, whereas the third patient died as a result of septic shock and multiple organ dysfunction.
