A simple laboratory test to measure protein C may offer a useful new indicator of the severity of illness and risk of death among critically ill patients according to study results.
Protein C is a natural anti-blood-clotting substance that also reflects the level of inflammation in the body. The new study is by Dr. Frank Brunkhorst and colleagues of Friedrich Schiller University in Jena, Germany. "Protein C may be a new target for therapy for patients with non-infectious-induced organ failure/dysfunction in the intensive care unit," said Dr. Brunkhorst. "The possibility to measure protein C levels at the bedside in critically ill patients—without time-delay by the central lab—would be a great step forward in assessing prognosis, and may influence clinical decision making at an early stage of the evolution of organ dysfunction."
The researchers analyzed the relationship between protein C and indicators of organ failure in 312 patients admitted to the intensive care unit (ICU) after major surgery. Changes in protein C levels over time were analyzed, along with their ability to predict the patients' risk of death.
About half of the patients had lower-than-normal protein C levels—reflecting an increased risk of abnormal blood clotting—when they first arrived at the ICU. Protein C decreased further over the next three to four days before returning to normal by about two weeks.
Lower protein C concentrations were correlated with increased severity of sepsis and with greater organ dysfunction. In contrast, patients with less-severe illness—based on standard severity scores—had higher protein C levels. Overall, 15 percent of patients died. Particularly during their first four days in the ICU, this group had lower protein C levels than patients who survived.
With adjustment for other factors, the risk of death was four times higher for patients whose minimum protein C level was below a certain cutoff point. Protein C was the strongest predictor of risk of death—even stronger than the standard severity scores.
MEDICA.de; Source: American Society of Anesthesiologists
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