A time-sensitive analysis of the prognostic utility of vasopressor dose in septic shock.
Adolescent
Adult
Aged
Aged, 80 and over
Cohort Studies
Critical Care
/ methods
Dose-Response Relationship, Drug
Female
Humans
Intensive Care Units
Male
Middle Aged
Norepinephrine
/ therapeutic use
Prognosis
Retrospective Studies
Shock, Septic
/ drug therapy
Survival Analysis
Time
Treatment Outcome
United Kingdom
Vasoconstrictor Agents
/ therapeutic use
Young Adult
prognostication
sepsis
septic shock
vasopressor dose
Journal
Anaesthesia
ISSN: 1365-2044
Titre abrégé: Anaesthesia
Pays: England
ID NLM: 0370524
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
accepted:
03
02
2021
pubmed:
10
3
2021
medline:
22
9
2021
entrez:
9
3
2021
Statut:
ppublish
Résumé
It is unclear whether the association between vasopressor dose and mortality is affected by duration of administration. We examined whether prognostication in septic shock is feasible through the use of daily median vasopressor doses. We undertook a single-centre retrospective cohort study. We included patients with a diagnosis of septic shock admitted to the intensive care unit at Queen Elizabeth Hospital, Birmingham, UK, between April 2016 and July 2019. The primary outcome measure was 90-day mortality. We defined vasopressor dose as the median norepinephrine equivalent dose (equivalent infusion rates of all vasopressors and inotropes) recorded for each day, for the first four days of septic shock. We divided patients into groups by vasopressor dose quintiles and calculated their 90-day mortality rate. We examined area under the receiver operator characteristic curves for prognostic ability. In total, 844 patients were admitted with septic shock and had a 90-day mortality of 43% (n = 358). Over the first four days, median vasopressor dose decreased in 93% of survivors and increased in 56% of non-survivors. The mortality rate associated with a given vasopressor dose quintile increased on sequential days of septic shock. The area under the receiver operator characteristic curves of daily median vasopressor dose against mortality increased from day 1 to day 4 (0.67 vs. 0.86, p < 0.0001). By day 4, a median daily vasopressor dose > 0.05 μg.kg
Substances chimiques
Vasoconstrictor Agents
0
Norepinephrine
X4W3ENH1CV
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1358-1366Informations de copyright
© 2021 Association of Anaesthetists.
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