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Recombinant activated protein C: the key is clinical assessment of risk of death, not subset analysis

R Phillip Dellinger1

  • 1Section of Critical Care Medicine, Cooper University Hospital, One Cooper Plaza, Camden, NJ 08103, USA. dellinger-phil@cooperhealth.edu

Critical Care (London, England)
|March 18, 2006
PubMed

Insights

The PROWESS trial showed recombinant activated protein C (rhAPC) reduced severe sepsis mortality by 6.1%. Despite initial findings, ongoing debate surrounds rhAPC

Area of Science:

  • Critical Care Medicine
  • Pharmacology
  • Clinical Trials

Background:

  • Severe sepsis poses a significant mortality risk.
  • Recombinant activated protein C (rhAPC) emerged as a potential therapeutic agent.
  • The PROWESS trial provided initial evidence for rhAPC efficacy.

Purpose of the Study:

  • To evaluate the clinical utility of rhAPC in severe sepsis.
  • To address criticisms and controversies surrounding the PROWESS trial.
  • To guide clinical practice regarding rhAPC use.

Main Methods:

  • Analysis of the PROWESS trial data.
  • Review of subsequent studies on rhAPC.
  • Synthesis of evidence to inform clinical decision-making.

Main Results:

  • The PROWESS trial reported a 6.1% absolute mortality reduction (p=0.005).
  • Subsequent research has generated both supporting and conflicting data.
  • Controversy persists regarding study design, analysis, and interpretation.

Conclusions:

  • The clinical application of rhAPC remains a subject of debate.
  • Evidence synthesis is crucial for navigating rhAPC use in clinical practice.
  • Further research may be needed to clarify rhAPC's role in severe sepsis management.

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