Critically Appraised Topic – Meta-analysis Human recombinant ...

• Also, there is no relationship between the effect of the drug and the importance ofprotein C deficiency. On the contrary, the effect of the drug is more evident in thegroup without protein C deficiency• The play of chance could explain the positive effect on 28-day mortality in participantswith APACHE II score of 25 or more. This possibility is supported by the ADDRESSstudy (Abraham 2005)• The risk of bias in the included studies is not negligible. Three of the four studiesincluded in this review (Abraham 2005; Bernard2001a; Nadel 2007) did not describe their randomization procedure.• Another major aspect that applied to all included studies was sponsorship by thepharmaceutical industry• More randomized trials are needed to establish the role of APC in management ofpatients with severe sepsis