In a real-world, single-center cohort of very sick patients with severe sepsis, drotrecogin alfa use was associated with high mortality and its usage declined over time due to uncertainty over its risk-benefit profile.
High mortality with drotrecogin alfa in severe sepsis urges clinical caution; leaves open its net benefit in current practice.
We present our experience with drotrecogin alfa (activated) in 110 patients. Data were collected on diagnosis, acuity, complications and outcomes. Crude ICU and hospital mortality was high at 47.3 and 55.5% respectively (hospital SMR = 1.02). Our patients appeared to be sicker than in other published series (mean number of organ failures = 4). The rate of serious bleeding events was comparable to the PROWESS trial. Usage fell during the study period from 37 patients in 2005 to 14 patients in 2008 and is likely to reflect uncertainty over the risk-benefit profile.
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Pathma‐Nathan et al. (2011) studied this question.
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