[Identification of patients suitable for therapy with activated Protein C]

Drotrecogin alpha (recombinant human activated protein C, rhAPC; Xigris) is an immune modulating treatment principle that has been shown to significantly reduce mortality in patients with severe sepsis. Currently, the identification of patients in intensive care that may benefit from such a treatment is insufficient. The importance of this evidence-based treatment modality is commonly ignored for reasons of increased cost. A medically justified and economically acceptable strategy with a medico-legal backing would be a procedure based on the design and the results of the PROWESS study. This may benefit patients with severe sepsis of not longer than 48 h duration, an APACHE II score of > or =25 or > or =2 failing organs and no exclusion criteria. Extending the indication beyond this group should be discussed as a last resort in patients with a fulminant clinical course, such as in meningitis, and based on data from retrospective subgroup analyses. Patients with severe sepsis following community-acquired pneumonia with progressive organ dysfunction may also benefit from activated protein C treatment in addition to an otherwise best standard of care.