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The PROWESS (Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis) trial demonstrated a 6.1% absolute decrease in mortality with a p value of 0.005. Despite the impressive results of this trial, criticism of the study has targeted various aspects of design, analysis and interpretation. Additional studies of recombinant activated protein C (rhAPC) have added to our understanding about this drug and to controversy as well. So how do we deal with rhAPC use in our clinical practice?

Recombinant activated protein C: the key is clinical assessment of risk of death, not subset analysis.