• Andrew D Shaw, George M Vail, Douglas J Haney, Jin Xie, and Mark D Williams.
• Department of Anesthesiology, Duke University, DUMC 3094, Durham, NC 27710, USA. andrew.shaw@duke.edu
• J Crit Care. 2011 Dec 1;26(6):539-45.

PurposeThe aim of this study was to assess the relationship between protein C levels and temporal changes in organ dysfunction.Materials And MethodsUsing data from the placebo arm of Recombinant Human Activated PROtein C Worldwide Evaluation in Severe Sepsis trial (N = 775), we compared the development of organ dysfunction over time, in adult severe sepsis patients with and without severe protein C deficiency.ResultsAt study enrollment (baseline), patients with and without severe protein C deficiency were similar in age and likelihood of comorbidities. Patients with severe protein C deficiency had lower arterial blood pressure (P = .0006), greater serum creatinine concentration (P < .0001), elevated markers of thrombosis and inflammation, and impairment of fibrinolysis (P < .0001). The baseline PaO(2)/FiO(2) ratio was not significantly different between the 2 groups. Seven days after study enrollment, cardiovascular and renal function remained significantly worse in patients with severe protein C deficiency (P < .0001), and respiratory dysfunction was greater (P < .0001). Baseline protein C deficiency was seen to be associated with subsequent pulmonary, renal, and hematologic organ failure.ConclusionsSevere protein C deficiency in patients with severe sepsis is associated with both the incidence and severity of organ dysfunction and subsequent worsening of organ function and may be a useful predictor of organ failure in severe sepsis.Copyright © 2011 Elsevier Inc. All rights reserved.

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