• M Crivellari, S Silvetti, C Gerli, G Landoni, A Franco, T Bove, F Pappalardo, and A Zangrillo.
• Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milano, Italy.
• Med Intensiva. 2014 Jun 1;38(5):278-82.

IntroductionActivated protein C is associated with a risk of bleeding and its effects on survival in septic shock patients are questionable. Protein C zymogen has no risk of bleeding and improves the outcome of patients with septic shock. We hereby describe the largest published case series of adult patients receiving protein C zymogen.Design, Setting And ParticipantsA prospective study on 23 adult patients with severe sepsis or septic shock, two or more organ failures and at high risk for bleeding, treated with protein C zymogen (50IU/kg bolus followed by continuous infusion of 3IU/kg/h for 72h).ResultsThe Z-test evidenced a significant reduction between the expected mortality (53%) and the observed mortality 30% (Z value=1.99, p=0.046) in our sample population. Protein C levels increased from 34±18% to 66±22% at 6h after PC bolus (p<0.001), and kept on increasing during 72h of administration (p<0.001 to baseline). Sequential Organ Failure Assessment (SOFA), score of organ dysfunction, decreased from baseline to 7 days after administration of protein C from 14±2 to 7±4 (p<0.001). No adverse event drug related was noted.ConclusionProtein C zymogen administration is safe and its use in septic patients should be investigated through a randomized controlled trial.Copyright © 2012 Elsevier España, S.L. and SEMICYUC. All rights reserved.

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