Predictors of prolonged vasopressin infusion for the treatment of septic shock.

Abstract

PURPOSE:

Prolonged catecholamine use has been linked with poor clinical outcomes, including higher mortality. The objective was to identify characteristics that may be predictive of prolonged arginine vasopressin (AVP) use for 7 days or more in patients with septic shock.

MATERIALS AND METHODS:

This was a retrospective nested cohort analysis of adult patients receiving AVP as initial hemodynamic support for septic shock, either alone or in combination with norepinephrine, between 2008 and 2010.

RESULTS:

Univariate factors predictive of patients requiring extended AVP support were peripheral vascular disease (PVD) (48% vs 18%, P = .001), congestive heart failure (30% vs 12%, P = .024), and acute kidney injury (AKI) (83% vs 49%, P = .003). Patients requiring extended AVP support more frequently experienced a new intensive care unit (ICU) arrhythmia, typically atrial fibrillation (39% vs 7%, P < .001), and had higher 28-day mortality (74% vs 20%, P < .001). Multivariate analysis revealed that the strongest independent predictors of prolonged AVP dependence were new ICU arrhythmia (odds ratio [OR], 5.3; 95% confidence interval [CI], 1.6-17.8), PVD (OR, 4.3; 95% CI, 1.4-13.1), and AKI (OR, 3.9; 95% CI, 1.1-14.5).

CONCLUSIONS:

Patients with preexisting PVD and AKI and those experiencing a new ICU arrhythmia on AVP may be more likely to remain on AVP for 7 or more days.

• Authors: Heather A Personett, Joanna L Stollings, Stephen S Cha, Lance J Oyen
• Journal: Journal of critical care (J Crit Care) Vol. 27 Issue 3 Pg. 318.e7-12 (Jun 2012) ISSN: 1557-8615 [Electronic] United States
• PMID: 22227078 (Publication Type: Journal Article)
• Copyright: Copyright © 2012 Elsevier Inc. All rights reserved.

Chemical References

• Vasoconstrictor Agents
• Arginine Vasopressin

Topics

• Adult
• Arginine Vasopressin (administration & dosage)
• Cohort Studies
• Female
• Hemodynamics
• Humans
• Logistic Models
• Male
• Multivariate Analysis
• Prognosis
• Retrospective Studies
• Risk Factors
• Shock, Septic (drug therapy, mortality)
• Survival Rate
• Time Factors
• United States (epidemiology)
• Vasoconstrictor Agents (administration & dosage)