Abstract | BACKGROUND: Inflammatory and coagulation processes are both affected in meningococcaemia. Severe acquired protein-C deficiency in meningococcaemia is usually associated with substantial mortality: in survivors, skin grafts, amputation, and end-organ failure are not uncommon. Protein C is a natural anticoagulant and also has important anti-inflammatory activity. We assessed the effects of early replacement therapy with protein-C concentrate together with continuous veno-venous haemodiafiltration and conventional treatment in meningococcaemia. METHODS: 12 patients aged between 3 months and 27 years with meningococcaemia and severe acquired protein-C deficiency (mean 0.20 IU/mL) were studied. All patients had septic shock, widespread purpura, skin necrosis, and disseminated intravascular coagulopathy. After a test dose of protein-C concentrate, patients received a continuous infusion with the dose adjusted daily to keep the plasma concentration between 0.8 and 1.2 IU/mL. 11 patients were given unfractionated intravenous heparin (10-15 IU kg-1 h-1). Nine patients had haemodiafiltration and one had peritoneal dialysis. The Glasgow meningococcal septicaemia prognostic score and the paediatric risk of mortality score predicted a minimum mortality of 80% and 57%, respectively. FINDINGS: INTERPRETATION: The acquired severe deficiency of protein C in meningococcaemia contributes to the pathogenesis of the thrombotic necrotic lesions in the skin and other organs and probably has an important role in the inflammatory response. Protein-C therapy is merely one approach to improve the host response in this syndrome. We suggest that a double-blind, randomised, controlled multicentre trial is needed to confirm our results.
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Authors | O P Smith, B White, D Vaughan, M Rafferty, L Claffey, B Lyons, W Casey |
Journal | Lancet (London, England)
(Lancet)
Vol. 350
Issue 9091
Pg. 1590-3
(Nov 29 1997)
ISSN: 0140-6736 [Print] England |
PMID | 9393338
(Publication Type: Clinical Trial, Journal Article)
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Chemical References |
- Anticoagulants
- Protein C
- Heparin
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Topics |
- Adolescent
- Adult
- Anticoagulants
(therapeutic use)
- Child
- Child, Preschool
- Female
- Hemodiafiltration
- Heparin
(therapeutic use)
- Humans
- IgA Vasculitis
(etiology, therapy)
- Male
- Meningitis, Meningococcal
(complications, therapy)
- Prognosis
- Protein C
(therapeutic use)
- Treatment Outcome
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