Drotrecogin alfa (activated): down and not out, but not really in either

doi:10.1186/cc5022

Critical Care

Volume 10
Issue 5

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Meade MO

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Letter

Drotrecogin alfa (activated): down and not out, but not really in either

Jan O Friedrich¹ , Neill KJ Adhikari² and Maureen O Meade³

¹Interdepartmental Division of Critical Care, University of Toronto, and Departments of Critical Care and Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, Canada M5B 1W8

²Interdepartmental Division of Critical Care, University of Toronto, and Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5

³Department of Critical Care, Hamilton Health Sciences, and Department of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5

author email corresponding author email

Critical Care 2006, 10:420doi:10.1186/cc5022


Published:	22 September 2006

See related letter by Agarwal and Nath, http://ccforum.com/content/10/4/416, related commentary by Friedrich et al., http://ccforum.com/content/10/3/145, related letter by Saxena and Andrews, http://ccforum.com/content/10/5/422, related letter by Williams et al., http://ccforum.com/content/10/5/424, and related reply by Friedrich et al., http://ccforum.com/content/10/6/427

First paragraph (this article has no abstract)

We read with interest the letter by Agarwal and Nath [1] in response to our commentary [2] analyzing current evidence for drotrecogin alfa (activated) (DrotAA) in the treatment of severe sepsis. Agarwal and Nath argue that our meta-analysis should have used a fixed-effects model, which ignores between-study heterogeneity, rather than a more conservative random-effects model, which includes it. Such a model shows significant benefit for DrotAA in patients with severe sepsis and at a high risk of death defined either by an Acute Physiology and Chronic Health Evaluation (APACHE) II score of 25 or more, or at least two organ dysfunctions.