tailieunhanh - Báo cáo khoa học: "Drotrecogin alfa (activated): current evidence supports treatment for severe sepsis patients with a high risk of death"

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: Drotrecogin alfa (activated): current evidence supports treatment for severe sepsis patients with a high risk of death. | Available online http content 10 5 424 Letter Drotrecogin alfa activated current evidence supports treatment for severe sepsis patients with a high risk of death Mark D Williams Jonathan M Janes and David R Nelson Lilly Research Laboratories Eli Lilly and Company Indianapolis Indiana USA Corresponding author Mark D Williams mardwill@ Published 30 October 2006 This article is online at http content 10 5 424 2006 BioMed Central Ltd Critical Care 2006 10 424 doi cc5062 See related commentary by Friedrich et al. http content 10 3 145 We read with interest the recent commentary by Friedrich and colleagues 1 that reported a meta-analysis of the two placebo-controlled clinical trials of Drotrecogin alfa activated DrotAa the PROWESS Recombinant Human Activated Protein C Worldwide Evaluation of Severe Sepsis 2 and ADDRESS Administration of Drotrecogin Alfa Activated in Early Stage Severe Sepsis 3 trials. Several methodological concerns in the analysis by Friedrich and colleagues severely limit the utility of the analysis and call into question the conclusions. In their meta-analysis the authors pooled all data from PROWESS and ADDRESS and conclude that there is no statistically significant treatment effect associated with Drot Aa in the overall population and in subgroups of patients with Acute Physiology And Chronic Health Evaluation APACHE II score 25 or multiple organ dysfunction MOD . Rather than relying on combining point estimates of pooled results we performed a more straightforward and standard metaanalysis for the MOD populations by combining patient level data to fit a logistic regression model with terms for treatment study and their interaction a fixed effect approach . This model yields a significant common treatment effect estimate with p . Given that the study interaction was non-significant we combined MOD data in an unadjusted analysis that yielded a significant common treatment effect estimate with p