Department of Anesthesiology, Duke University, DUMC 3094, Durham, NC 27710, USA.
J Crit Care. 2011 Dec;26(6):539-45. doi: 10.1016/j.jcrc.2011.05.006. Epub 2011 Jul 6.
The aim of this study was to assess the relationship between protein C levels and temporal changes in organ dysfunction.
Using 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.
At 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.
Severe 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.
本研究旨在评估蛋白 C 水平与器官功能障碍的时间变化之间的关系。
利用来自严重脓毒症患者重组人激活蛋白 C 全球评估研究（n = 775）安慰剂组的数据，我们比较了有无严重蛋白 C 缺乏的成年严重脓毒症患者的器官功能障碍随时间的发展情况。
在研究入组时（基线），有严重蛋白 C 缺乏的患者与无严重蛋白 C 缺乏的患者在年龄和合并症的可能性方面相似。严重蛋白 C 缺乏的患者的动脉血压较低（P =.0006），血清肌酐浓度较高（P <.0001），血栓和炎症标志物升高，纤维蛋白溶解受损（P <.0001）。两组间的基线 PaO(2)/FiO(2) 比值无显著差异。入组后 7 天，严重蛋白 C 缺乏患者的心血管和肾功能仍明显较差（P <.0001），呼吸功能障碍更严重（P <.0001）。基线蛋白 C 缺乏与随后的肺部、肾脏和血液学器官衰竭有关。
严重脓毒症患者的严重蛋白 C 缺乏与器官功能障碍的发生和严重程度以及随后的器官功能恶化有关，可能是严重脓毒症器官衰竭的一个有用预测指标。
