tailieunhanh - Báo cáo y học: "Activated protein C in severe acute pancreatitis without sepsis"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Activated protein C in severe acute pancreatitis without sepsis? | Shankar-Hari and Wyncoll Critical Care 2010 14 188 http content 14 4 188 CRITICAL CARE COMMENTARY L__ Activated protein C in severe acute pancreatitis without sepsis Not just yet . Manu Shankar-Hari and Duncan Wyncoll See related research by Pettila etal. http content 14 4 R139 abstract Abstract Severe acute pancreatitis SAP is characterized by an unregulated systemic proinflammatory response secondary to activation of trypsin within the pancreatic tissue resulting in multiple organ failure. This dysregulated inflammation leading to organ dysfunction also characterizes severe sepsis. Activated protein C APC has pleotropic effects on the immune coagulation inflammatory and apoptotic pathways and has been postulated to benefit acute pancreatitis -although concerns of possible retroperitoneal bleeding remain. Currently experimental studies and subgroup data on patients with pancreatitis from a randomized controlled trial of APC in severe sepsis form the literature on the possible role of APC in SAP We review the first randomized controlled trial of APC in acute pancreatitis published in the present issue of Critical Care. In the present issue of Critical Care Pettila and colleagues report the first single-centred pilot randomized controlled trial of activated protein C APC in alcohol-induced acute pancreatitis of moderate severity but without infection 1 . After screening 215 patients 32 patients satisfied the trial inclusion criteria and were randomized to either placebo or APC at 24 pg kg hour for 96 hours in addition to standard therapy for acute pancreatitis. The study - powered to evaluate the effect of APC on the change in organ dysfunction measured using the Sequential Organ Failure Assessment score as the primary outcome - failed to show any benefit. In acute pancreatitis severity is defined by the occurrence of organ failure and or peri-pancreatic complications. Severe acute pancreatitis SAP is characterized by the presence of