tailieunhanh - Báo cáo khoa học: "The staging of sepsis: understanding heterogeneity in treatment efficacy"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: The staging of sepsis: understanding heterogeneity in treatment efficacy. | Critical Care December 2005 Vol 9 No 6 Marshall Commentary The staging of sepsis understanding heterogeneity in treatment efficacy John C Marshall Professor of Surgery Departments of Surgery and Critical Care Medicine University of Toronto Toronto Ontario Canada Corresponding author John C Marshall Published online 22 November 2005 This article is online at http content 9 6 626 2005 BioMed Central Ltd Critical Care 2005 9 626-628 DOI cc3907 See related research by Macias et al. in this issue http content 9 6 R607 Abstract Human sepsis is an intrinsically complex disease. Populations of patients enrolled into clinical trials of novel sepsis therapies are notoriously heterogeneous with respect to the inciting cause of their disease the co-morbid conditions that define its course and the acute severity of their initial presentation. This heterogeneity is reflected in strikingly variable mortality risks across studies and probably though less clearly-established in variable response rates to a given intervention. In an accompanying article in this issue of Critical Care Macias and colleagues argue that the effectiveness of adjuvant sepsis therapies is not dependent on the baseline mortality risk since the few positive trials that have been published show widely divergent placebo mortality rates. But this analysis assumes that biologically distinct interventions will be equally efficacious in clinically diverse populations and confuses severity as a population descriptor with severity as a surrogate measure of a biologic state in an individual patient. In a pivotal trial of recombinant human activated protein C rhAPC in patients with severe sepsis an aggregate 6 mortality decrement appeared to be the result of negligible efficacy in the least severely ill patients and considerably greater efficacy in those who were at greatest risk of dying. A larger follow-up study recruiting low risk patients confirmed this .