# Protein C in adult patients with sepsis: from pathophysiology to monitoring and supplementation

## TL;DR

Protein C helps reduce inflammation and coagulation in sepsis, but its monitoring and supplementation in adults remain under-researched and debated.

## Contribution

The paper reviews the role of Protein C in sepsis and highlights the need for further studies on its therapeutic use in adult patients.

## Key findings

- Low Protein C levels in sepsis are linked to higher risks of organ failure and mortality.
- Protein C supplementation's efficacy in sepsis remains debated due to limited clinical evidence.
- Monitoring Protein C levels is relevant in specific sepsis-related conditions like purpura fulminans and DIC.

## Abstract

Protein C (PC) plays a crucial role in modulating inflammation and coagulation in sepsis. Its anticoagulant and cytoprotective properties are critical in mitigating sepsis-induced coagulopathy, which is associated with high mortality rates. In sepsis, low levels of PC are associated with an elevated risk of multiple organ dysfunction and increased mortality. Routine monitoring of PC levels is not widely implemented but appears relevant in selected populations, such as patients with purpura fulminans, sepsis-induced coagulopathy (SIC), disseminated intravascular coagulopathy (DIC) or hyperinflammatory septic shock phenotypes. Treatment with PC has been limited to PC concentrate approved for paediatric use in congenital PC deficiencies and purpura fulminans, while the efficacy of PC supplementation in sepsis remains a subject of debate. Considering the physiological significance of PC and its role in sepsis pathophysiology, additional studies are necessary to fully elucidate its therapeutic efficacy in specific clinical settings.