Recombinant Human Activated Protein C Reduces Mortality of Severe Sepsis-Related ARDS

人類合成活性蛋白質C降低嚴重敗血症引發急性呼吸窘迫症候群病人之死亡率

陳欽明(Chin-Ming Chen) ； 余文良(Wen-Liang Yu) ； 陳奇祥(Khee-Siang Chan) ； 曾桂玲(Kuei-Ling Tseng) ； 鄭高珍(Kuo-Chen Cheng)

《胸腔醫學》 23卷4期 (2008/08) Pp. 239-251

https://doi.org/10.29806/TM.200808.0002

摘要

前言：我們嘗試去評估南台灣某一醫學中心成人加護病房，其嚴重敗血症引發急性呼吸窘迫症候群病人之預後，特別針對使用人類合成活性蛋白質C之後的成效，這些病人在文獻上仍然少有報導。
方法：本回溯、觀察性研究自2004年1月至2006年6月，蒐集所有嚴重敗血症引發急性呼吸窘迫症候群、並使用呼吸器之病患，及部份病人在使用合成活性蛋白質C之後的預後。病人均符合美國－歐洲共同會議(American-European Consensus Conference)之急性呼吸窘迫症候群定義，且APACHE Ⅱ分數≥25合併多重器官衰竭。
結果：在30個月內，共蒐集64個病人。在9473次使用呼吸器而住院的病人中，嚴重敗血症引發急性呼吸窘迫症候群佔0.7%。其入院之平均APACHE Ⅱ分數為29.3±4.7，住院之死亡率為67.2%。比起非治療組，使用合成活性蛋白質C組之人口學及住院狀況類似，除了其28天及住院之死亡率較低（分別是37.5% vs. 66.7% and 43.8% vs. 75%），但有較高之住院費用（23,851 vs. 11,376美金）。經多變項分析顯示，使用合成活性蛋白質C會降低嚴重敗血症引發急性呼吸窘迫症候群病人之死亡率。
結論：嚴重敗血症引發急性呼吸窘迫症候群病人擁有高死亡率。趕快使用合成活性蛋白質C可以顯著降低這些嚴重病人的死亡率，僅管它的住院費用較高。

關鍵字

急性呼吸窘迫症候群 ； 死亡率 ； 多重器官衰竭 ； 人類合成活性蛋白質C ； 嚴重敗血症

並列摘要

Introduction: We attempted to investigate the prognosis of severe sepsis-related acute respiratory distress syndrome (ARDS) in adult patients admitted to intensive care units (ICUs) at a medical center in southern Taiwan, especially focusing on the efficacy of recombinant human activated protein C (rhAPC), which is still rarely highlighted in such patients.
Methods: From January 2004 to June 2006, we performed a retrospective, observational cohort study to investigate the impact of rhAPC on the prognosis of ARDS patients with mechanical ventilation, who met the criteria of the American-European Consensus Conference (AECC) definition of ARDS, and who had the presence of sepsis with high acute physiology and chronic health evaluation Ⅱ (APAC HE Ⅱ) score of ≥25 and multiple organ failure.
Results: Over a 30-month period, a total of 64 patients were enrolled. The incidence of sepsis-related ARDS was 0.7% of 9473 ICU admissions with mechanical ventilation and an APACHE Ⅱ of 29.3 ± 4.7 at inclusion. The hospital mortality rate was 67.2%. The rhAPC-treated group had similar demographic and clinical data except a significantly lower rate of 28-day and hospital mortality (37.5% vs. 66.7% and 43.8% vs. 75%, respectively), but also a higher total hospital cost (USD23, 851 vs. USD11, 376) compared with the non-rhAPC group. Using multivariate analyses, rhAPC infusion was shown to significantly influence the mortality of sepsis-related ARDS.
Conclusion: Severe sepsis-related ARDS possessed a high hospital mortality rate. Prompt initiation of rhAPC infusion may significantly reduce the mortality rate in these severely ill patients regardless of higher hospital expenditure.

並列關鍵字

acute respiratory distress syndrome ； mortality ； multiple organ failure ； recombinant human activated protein C ； severe sepsis