Furthermore, little progress has been made in the management of patients with cirrhosis and sepsis, as these patients tend to be excluded from studies of therapeutics in severe sepsis, such as the study of activated protein C in severe sepsis.15 Because the baseline central and mixed venous oxygen saturation tends to be higher in patients with cirrhosis,18 this specific goal for early goal directed therapy16 may not be applicable to these patients. This evidence concerns the gene PROC and Sepsis.