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Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care cung cấp cho các bạn kiến thức về ngành y đề tài: Activated protein C in sepsis: down but not out, yet. | Available online http ccforum.eom content 10 4 416 Letter Activated protein C in sepsis down but not out yet Ritesh Agarwal and Alok Nath Department of Pulmonary Medicine Postgraduate Institute of Medical Education and Research Chandigarh India Corresponding author Ritesh Agarwal ritesh@indiachest.org Published 26 July 2006 This article is online at http ccforum.com content 10 4 416 2006 BioMed Central Ltd Critical Care 2006 10 416 doi 10.1186 cc4988 See related commentary by Friedrich et al. http ccforum.com content 10 3 145 We read with interest the recent commentary by Friedrich and coworkers 1 in which they consider whether the current evidence supports treatment for severe sepsis with drotrecogin alfa activated . They conclude that the survival benefit is weak in patients with severe sepsis treated with activated protein C APC 1 . However this conclusion has a number of limitations. First the authors have summated the individual studies by using a random effects model. Although the random effects model is generally used in the presence of significant heterogeneity statistical tests erroneously detect heterogeneity when there are few studies 2 . Another problem with this model is that by adding a constant number to the weight of each study the relative contributions of each trial become more equal. This can have a marked effect on the results and only seldom does it afford an appropriate representation of the efficacy expected 3 4 . In fact if we use a fixed effects model then there is significant benefit with the use of APC in both of the classic indications namely Acute Physiology and Chronic Health Evaluation II score above 25 odds ratio 0.71 95 confidence interval CI 0.56-0.91 and two or more organ dysfunctions odds ratio 0.78 95 CI 0.64-0.94 with the numbers needed to treat being 14 95 CI 8-46 and 20 95 CI 12-72 respectively. The problem thus lies with the recognition of heterogeneity in a trial which includes clinical heterogeneity variability in the .
