Hydrocortisone versus vasopressin for the management of adult patients with septic shock refractory to norepinephrine: A multicenter retrospective study.
hydrocortisone
norepinephrine
sepsis
septic shock
vasopressin
Journal
Pharmacotherapy
ISSN: 1875-9114
Titre abrégé: Pharmacotherapy
Pays: United States
ID NLM: 8111305
Informations de publication
Date de publication:
08 2023
08 2023
Historique:
revised:
03
04
2023
received:
04
01
2023
accepted:
10
04
2023
medline:
25
8
2023
pubmed:
6
5
2023
entrez:
6
5
2023
Statut:
ppublish
Résumé
Significant practice variation exists when selecting between hydrocortisone and vasopressin as second line agents in patients with septic shock in need of escalating doses of norepinephrine. The goal of this study was to assess differences in clinical outcomes between these two agents. Multicenter, retrospective, observational study. Ten Ascension Health hospitals. Adult patients with presumed septic shock receiving norepinephrine prior to study drug initiation between December 2015 and August 2021. Vasopressin (0.03-0.04 units/min) or hydrocortisone (200-300 mg/day). A total of 768 patients were included with a median (interquartile range) SOFA score of 10 (8-13), norepinephrine dose of 0.3 mcg/kg/min (0.1-0.5 mcg/kg/min), and lactate of 3.8 mmol/L (2.4-7.0 mmol/L) at initiation of the study drug. A significant difference in 28-day mortality was noted favoring hydrocortisone as an adjunct to norepinephrine after controlling for potential confounding factors (OR 0.46 [95% CI, 0.32-0.66]); similar results were seen following propensity score matching. Compared to vasopressin, hydrocortisone initiation was also associated with a higher rate of hemodynamic responsiveness (91.9% vs. 68.2%, p < 0.01), improved resolution of shock (68.8% vs. 31.5%, p < 0.01), and reduced recurrence of shock within 72 h (8.7% vs. 20.7%, p < 0.01). Addition of hydrocortisone to norepinephrine was associated with a lower 28-day mortality in patients with septic shock, compared to the addition of vasopressin.
Substances chimiques
Norepinephrine
X4W3ENH1CV
Hydrocortisone
WI4X0X7BPJ
Vasoconstrictor Agents
0
Vasopressins
11000-17-2
Types de publication
Multicenter Study
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
787-794Informations de copyright
© 2023 Pharmacotherapy Publications, Inc.
Références
Paoli CJ, Reynolds MA, Sinha M, Gitlin M, Crouser E. Epidemiology and costs of sepsis in the United States-an analysis based on timing of diagnosis and severity level. Crit Care Med. 2018;46(12):1889-1897. doi:10.1097/CCM.0000000000003342
Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181-1247. doi:10.1007/s00134-021-06506-y
Landry DW, Levin HR, Gallant EM, et al. Vasopressin deficiency contributes to the vasodilation of septic shock. Circulation. 1997;95:1122-1125. doi:10.1161/01.CIR.95.5.1122
Holmes CL, Patel BM, Russell JA, Walley KR. Physiology of vasopressin relevant to management of septic shock. Chest. 2001;120(3):989-1002. doi:10.1378/chest.120.3.989
Russell JA, Walley KR, Singer J, et al. Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med. 2008;358(9):877-887. doi:10.1056/NEJMoa067373
Gordon AC, Mason AJ, Thirunavukkarasu N, et al. Effect of early vasopressin vs norepinephrine on kidney failure in patients with septic shock: the VANISH randomized clinical trial. Jama. 2016;316(5):509-518. doi:10.1001/jama.2016.10485
Marik PE, Zaloga GP. Adrenal insufficiency during septic shock. Crit Care Med. 2003;31(1):141-145. doi:10.1097/00003246-200301000-00022
Ullian ME. The role of corticosteroids in the regulation of vascular tone. Cardiovasc Res. 1999;41(1):55-64. doi:10.1016/s0008-6363(98)00230-2
Annane D. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. Jama. 2002;288(7):862-871. doi:10.1001/jama.288.7.862
Sprung CK, Annane D, Keh D, et al. Hydrocortisone therapy for patients with septic shock. New Engl J Med. 2008;358:111-124. doi:10.1056/NEJMoa071366
Venkatesh B, Finfer S, Cohen J, et al. Adjunctive glucocorticoid therapy in patients with septic shock. N Engl J Med. 2018;378(9):797-808. doi:10.1056/NEJMoa1705835
Annane D, Renault A, Brun-Buisson C, et al. Hydrocortisone plus fludrocortisone for adults with septic shock. N Engl J Med. 2018;378(9):809-818. doi:10.1056/NEJMoa1705716
World Medical Association. World medical association declaration of Helsinki: ethical principles for medical research involving human subjects. Jama. 2013;310(20):2191-2194. doi:10.1001/jama.2013.281053
Brinton DL, Ford DW, Martin RH, Simpson KN, Goodwin AJ, Simpson AN. Missing data methods for intensive care unit SOFA scores in electronic health records studies: results from a Monte Carlo simulation. J Comp Eff Res. 2022;11(1):47-56. doi:10.2217/cer-2021-0079
Goradia S, Sardaneh AA, Narayan SW, Penm J, Patanwala AE. Vasopressor dose equivalence: a scoping review and suggested formula. J Crit Care. 2021;61:233-240. doi:10.1016/j.jcrc.2020.11.002
Russell JA, Walley KR, Gordon AC, et al. Interaction of vasopressin infusion, corticosteroid treatment, and mortality of septic shock. Crit Care Med. 2009;37(3):811-818. doi:10.1097/CCM.0b013e3181961ace
Ammar MA, Ammar AA, Wieruszewski PM, et al. Timing of vasoactive agents and corticosteroid initiation in septic shock. Ann Intensive Care. 2022;12(1):47. doi:10.1186/s13613-022-01021-9
Ragoonanan D, Allen B, Cannon C, Rottman-Pietrzak K, Bello A. Comparison of early versus late initiation of hydrocortisone in patients with septic shock in the ICU setting. Ann Pharmacother. 2022;56(3):264-270. doi:10.1177/10600280211021103
Sacha GL, Chen AY, Palm NM, Duggal A. Evaluation of the initiation timing of hydrocortisone in adult patients with septic shock. Shock. 2021;55(4):488-494. doi:10.1097/SHK.0000000000001651
Sacha GL, Lam SW, Wang L, Duggal A, Reddy AJ, Bauer SR. Association of Catecholamine Dose, lactate, and shock duration at vasopressin initiation with mortality in patients with septic shock. Crit Care Med. 2022;50(4):614-623. doi:10.1097/CCM.0000000000005317