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Am J Respir Crit Care Med. 2008 Sep 15;178(6):618-23. doi: 10.1164/rccm.200803-419OC. Epub 2008 Jun 19.

Randomized clinical trial of activated protein C for the treatment of acute lung injury.

Author information

1
Division of Nephrology and Critical Care Medicine, Department of Medicine, Box 0532, University of California, San Francisco, San Francisco, CA 94143-0532, USA. kathleen.liu@ucsf.edu

Abstract

RATIONALE:

Microvascular injury, inflammation, and coagulation play critical roles in the pathogenesis of acute lung injury (ALI). Plasma protein C levels are decreased in patients with acute lung injury and are associated with higher mortality and fewer ventilator-free days.

OBJECTIVES:

To test the efficacy of activated protein C (APC) as a therapy for patients with ALI.

METHODS:

Eligible subjects were critically ill patients who met the American/European consensus criteria for ALI. Patients with severe sepsis and an APACHE II score of 25 or more were excluded. Participants were randomized to receive APC (24 microg/kg/h for 96 h) or placebo in a double-blind fashion within 72 hours of the onset of ALI. The primary endpoint was ventilator-free days.

MEASUREMENTS AND MAIN RESULTS:

APC increased plasma protein C levels (P = 0.002) and decreased pulmonary dead space fraction (P = 0.02). However, there was no statistically significant difference between patients receiving placebo (n = 38) or APC (n = 37) in the number of ventilator-free days (median [25-75% interquartile range]: 19 [0-24] vs. 19 [14-22], respectively; P = 0.78) or in 60-day mortality (5/38 vs. 5/37 patients, respectively; P = 1.0). There were no differences in the number of bleeding events between the two groups.

CONCLUSIONS:

APC did not improve outcomes from ALI. The results of this trial do not support a large clinical trial of APC for ALI in the absence of severe sepsis and high disease severity.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00112164.

Comment in

PMID:
18565951
PMCID:
PMC2542435
DOI:
10.1164/rccm.200803-419OC
[Indexed for MEDLINE]
Free PMC Article

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