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  • Sepsis in Critically Ill Patients at a Community Acute Care Hospital: DISCUSSION


This drug-use evaluation was performed to evaluate the utilization and outcomes associated with DAA in a real-life clinical setting and to compare the results with those reported from clinical trials.

The preprinted order appeared to be facilitating the appro­priate utilization of DAA at this institution. The single case in which the use of DAA did not meet established institutional criteria involved a young man for whom the physician felt that the drug should be used, despite the patient having only 1 dysfunctional organ and an APACHE II score of 19. There were no serious bleeding events during the infusion, and the patient survived. The use of DAA in this patient occurred before publication of the Administration of Drotrecogin Alfa (Activated) in Early Stage Severe Sepsis (ADDRESS) trial, which showed no mortality benefit but an increased risk of serious bleeding associated with the use of DAA in patients with severe sepsis but low risk of death (APACHE II score less than 25). We did not evaluate appropriateness of utilization from the perspective of patients who had an indication for use of this drug but did not receive it. levitra professional

The patients who received DAA at this institution had greater severity of illness than those in the PROWESS study, as indicated by mean APACHE II score and number of dysfunc­tional organs or systems. Given the cost and potential for adverse effects associated with this drug, DAA therapy at the author’s institution was limited to patients with at least 2 dysfunctional organs or systems and an APACHE II score of at least 25. In the PROWESS study, about 75% of patients had at least 2 dysfunctional organs or systems at the time of enrollment, and the largest benefit associated with DAA use appeared to be for patients with a higher risk of mortality, as defined by APACHE II score of at least 25.

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