Biomarker response to drotrecogin alfa (activated) in children with severe sepsis: Results from the RESOLVE clinical trial

Objective: REsearching severe Sepsis and Organ dysfunction in children: A gLobal perspective (RESOLVE), a phase III trial of drotrecogin alfa (activated) in pediatric severe sepsis, examined biomarker changes in inflammation and coagulation. This report describes biomarker profiles in early severe sepsis and the pharmacodynamic assessment of drotrecogin alfa (activated) in RESOLVE. Design: Serial measurements of interleukin-1 beta, interleukin-6, interleukin-8, interleukin-10, tissue necrosis factor-alpha, procalcitonin, D-dimer, and thrombin-antithrombin complex were performed at baseline and daily over the first five study days. Protein C levels were performed at baseline and at the end of the 96-hr study drug infusion. Analysis of variance-based log-transformed data compared the treatment groups for each measured variable. Setting: One hundred four pediatric intensive care units in 18 countries. Patients: Four hundred seventy-seven children between 38 wks corrected gestational age and 17 yrs with sepsis-induced cardiovascular and respiratory dysfunction. Interventions: Drotrecogin alfa (activated). Measurements and Main Results: Pharmacodynamic activity of drotrecogin alfa (activated) compared with placebo was observed with reduction of d-dimer on day 1 (p <. 01) and thrombin-antithrombin complex on days 1-4 (p <. 05). There were no significant changes by treatment in multiple cytokines or procalcitonin. In the overall population, a median protein C difference was not observed (p > .05) with drotrecogin alfa (activated) administration compared with placebo, although a difference (median percentage change from baseline) in favor of drotrecogin alfa (activated) was observed in patients > 1 yr old (p = .0449). Conclusions: While children in the RESOLVE trial were similar to adults in that they showed a relationship between severity of coagulation and inflammation abnormalities and mortality, their pharmacodynamic response to drotrecogin alfa (activated) differed with respect to changes in protein C activity and systemic inflammation. (Pediatr Crit Care Med 2012; 13:639-645)