Evaluating the use of Drotrecogin alfa (activated) in adult severe sepsis: a Canadian multicenter observational study
Evaluating the use of Drotrecogin alfa (activated) in adult severe sepsis: a Canadian multicenter observational study
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DOI：
10.1007/s00134-007-0555-9
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发表时间：
2007-03-01
影响因子：
38.9
通讯作者：
Burry, Lisa
中科院分区：
文献类型：
--
作者：
Kanji, Salmaan;Perreault, Marc M.;Burry, Lisa
背景：本研究的目的是描述安大略和魁北克1年内DAA的使用模式和临床结局。方法：邀请安大略和魁北克所有在处方集上有DAA的医院参加。回顾性确定了2003年3月1日至2004年2月29日接受DAA的连续性患者。通过图表审查收集人口统计学、治疗和结局变量。对相关变量进行描述性统计，沿着逻辑回归以确定生存和出血的相关风险因素。结果：37个研究中心参与了261个DAA疗程。总死亡率为45%;年龄（> 65岁）、多器官系统衰竭（> 3）和院内感染源是死亡率的预测因素，而早期给予DAA（< 12 h）与较低的死亡率相关。10%的患者发生严重出血事件。仅观察到1例（0.4%）致死性颅内出血。多器官系统衰竭（≥ 4）和DAA的相对禁忌症是出血事件的预测因素。释义：与使用DAA相关的死亡率和出血并发症高于随机试验中报告的，但与其他使用数据库相似。这可能是由于在该患者队列中观察到的疾病严重程度较高。与死亡率和出血相关的可变风险，如治疗时间和相关禁忌症的知识，应成为进一步研究和未来教育工作的目标，以优化DAA的风险-受益比。
Background: The purpose of this study was to characterize the usage patterns and clinical outcomes of DAA in Ontario and Quebec over a 1-year period. Methods: All hospitals with DAA on formulary in Ontario and Quebec were invited to participate. Consecutive patients who received DAA from 1 March 2003 to 29 February 2004 were identified retrospectively. Demographic, treatment, and outcome variables were collected via chart review. Descriptive statistics on relevant variables were performed, along with logistic regression to determine relevant risk factors for survival and bleeding. Results: Thirty-seven sites participated with a total of 261 courses of DAA administered. The overall mortality rate was 45%; age (> 65 years), multiple organ system failure (> 3), and nosocomial source of sepsis werepredictors of mortality, whereas early DAA administration (< 12 h) was associated with lower mortality. Serious bleeding events occurred in 10% of the patients. Only 1 case ( 0.4%) of fatal intracranial bleed was observed. Multiple organ system failure (>= 4) and relative contraindications to DAA were predictors of bleeding events. Interpretation: Mortality and bleeding complications associated with the use of DAA were higher than that reported in randomized trials but similar to other usage database. This may be due to the higher severity of illness seen in this cohort of patients. Modifiable risks associated with mortality and bleeding, such as time to treatment, and knowledge of relative contraindications should be targets of further research and future educational efforts in order to optimize the risk-to-benefit ratio of DAA.