Critical Care and Shock

Recombinant Human Activated Protein C in Neurocritical Care: Case Series and Literature Review of Spinal Cord Injury, Severe Sepsis, and Recombinant Human Activated Protein C Therapy

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Spinal cord injury (SCI) is a serious condition that produces lifelong disabilities, with only limited therapeutic measures currently available. The incidence of SCI in the United States is estimated to be 30-40 cases per one million inhabitants, with resultant in-hospital mortality of 20 to 52 percent. (1,2) Traumatic SCI is followed by a progressive injury process that involves various pathophysiological events that lead to tissue destruction. Although the mechanisms are not fully understood, progressive vascular events, such as ischemia/reperfusion-induced endothelial damage, are involved in this process. As in sepsis, studies have demonstrated that activated neutrophils are important in inducing the damage to endothelial cells. (3) A common complication in patients with SCI is sepsis, which is associated with acute organ dysfunction, and results in a generalized inflammatory and procoagulant state. Sepsis is a major cause of death in intensive care units worldwide, with mortality rates that range from 20% for sepsis to 40% for severe sepsis to >60% for septic shock, that if related to SCI may be aggravated with concomitant spinal shock. We describe our experience with recombinant human activated protein C (rhAPC) in patients with SCI and severe sepsis (SS).