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An analysis of the PROWESS data indicates that 36.2% of the 1690 PROWESS patients met the AEC without the 8-hour time restriction and 5.7% met the criteria with the 8-hour time restriction for enrollment in the study by Annane and coworkers [ 15].
Dhainaut et al. [ 25] showed in subgroup analysis of the PROWESS trial that IL-6 levels fell more rapidly in the rhAPC group than in the control group.
In a subgroup analysis of the PROWESS trial, patients with higher risk of death had a larger drop in hospital mortality compared to patients with a lower risk of death.
However, in the post-hoc analysis of the PROWESS data by Dhainaut et al., there were no significant differences in IL-6 levels between the rhAPC group and the control group [ 12].
Vincent et al. [ 22] showed in subgroup analysis of the PROWESS trial that patients in the rhAPC group had significantly decreased SOFA scores for cardiovascular and respiratory dysfunction (P = 0.009 for both) compared to the control group for days 1 to 7. The beneficial effects of rhTM on organ damage in the present study were similar to those of rhAPC.
However, subgroup analysis of the PROWESS trial suggested a benefit solely for 'high risk' patients, and the original US Food and Drug Administration FDAA) license was limited to this subgroup; for 'low risk' patients, concerns about side-effects and lack of benefit meant that a follow-up study was requested [ 14, 15].
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In the present retrospective analysis of the PROWESS-Shock trial database, we were unable to find a noticeable positive impact from intravenous steroids for treatment of septic shock at baseline either in patients randomized to DrotAA or those randomized to placebo.
Analysis of the ADDRESS and PROWESS studies suggests that an enrollment sequence effect was present in both studies.
The European regulatory body approved rhAPC for multiple organ failure (again based on subset data analysis from the PROWESS trial demonstrating increased treatment effect as the number of organ failures increased).
Subgroup analysis of PROWESS and the subsequent ADDRESS [ 2] study have shown that only the sickest patients (at least two organ failures or APACHE II score >25) benefit from APC. Treatment is associated with an increased risk of serious bleeding, and so the use of APC is contraindicated in patients at high risk for this complication.
The US Food and Drug Administration has approved drotrecogin alfa (activated) for the treatment of patients with severe sepsis but, following a post hoc analysis of data from the PROWESS study, it has restricted the treatment to patients at a high risk for death (e.g. as determined by Acute Physiology and Chronic Health Evaluation II score) [ 2- 4].
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com