Vasopressin Initiation Timing and In-Hospital Mortality in Septic Shock: An Observational Study of Large Public Databases
IMPORTANCE:. Vasopressin is used in one-third of patients with septic shock to augment hemodynamics and reduce overall catecholamine exposure. However, the optimal clinical context in which to initiate vasopressin is unknown. OBJECTIVES:. To determine the association between norepinephrine-equivalen...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2025-09-01
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| Series: | Critical Care Explorations |
| Online Access: | http://journals.lww.com/10.1097/CCE.0000000000001284 |
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| author | Gretchen L. Sacha, PharmD Abhijit Duggal, MD, MPH, MSc Anita J. Reddy, MD, MBA Lu Wang, MS Seth R. Bauer, PharmD |
| author_facet | Gretchen L. Sacha, PharmD Abhijit Duggal, MD, MPH, MSc Anita J. Reddy, MD, MBA Lu Wang, MS Seth R. Bauer, PharmD |
| author_sort | Gretchen L. Sacha, PharmD |
| collection | DOAJ |
| description | IMPORTANCE:. Vasopressin is used in one-third of patients with septic shock to augment hemodynamics and reduce overall catecholamine exposure. However, the optimal clinical context in which to initiate vasopressin is unknown.
OBJECTIVES:. To determine the association between norepinephrine-equivalent dose, lactate concentration, and time duration from shock onset at vasopressin initiation with in-hospital mortality
DESIGN, SETTING, AND PARTICIPANTS:. Retrospective, observational evaluation utilizing Medical Information Mart for Intensive Care-IV and electronic ICU Collaborative Research Database databases of adult patients with septic shock based on modified Sepsis-3 criteria receiving continuous infusion catecholamines.
MAIN OUTCOMES AND MEASURES:. The associations of norepinephrine-equivalent dose, lactate concentration, and time duration from shock onset at vasopressin initiation with in-hospital mortality were evaluated with multivariable regression models.
RESULTS:. In total, 1409 patients from 209 hospitals were included. At vasopressin initiation patients had a median (interquartile range) norepinephrine-equivalent dose 28.4 µg/min (16.4–42.6 µg/min), lactate concentration 3.7 mmol/L (2.5–6.2 mmol/L), and 5.6 hours (2.0–13.5 hr) had elapsed since shock onset. All three variables of interest were associated with in-hospital mortality. Three restricted cubic spline knots were identified where the relationship between norepinephrine-equivalent dose and in-hospital mortality changed substantially: 9, 28, and 72 µg/min. The odds of in-hospital mortality increased by 90% and 3.9-fold when comparing vasopressin initiation at norepinephrine-equivalent doses of 28 µg/min and 72 µg/min to 9 µg/min, respectively (adjusted odds ratio [OR], 1.90 [95% CI, 1.49–2.41] and 3.93 [95% CI, 2.74–5.64]). The odds of in-hospital mortality increased by 16% for every mmol/L in the lactate concentration at vasopressin initiation (adjusted OR, 1.16 [95% CI, 1.11–1.21]). Finally, the odds of in-hospital mortality increased by 3% for every hour in the time duration from shock onset to vasopressin initiation (adjusted OR, 1.03 [95% CI, 1.01–1.04]).
CONCLUSIONS AND RELEVANCE:. Earlier adjunctive vasopressin initiation may decrease mortality in patients with septic shock. |
| format | Article |
| id | doaj-art-2e43e2064eb94b29b5ca99653b7ad6a2 |
| institution | Kabale University |
| issn | 2639-8028 |
| language | English |
| publishDate | 2025-09-01 |
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| series | Critical Care Explorations |
| spelling | doaj-art-2e43e2064eb94b29b5ca99653b7ad6a22025-08-26T03:23:56ZengWolters KluwerCritical Care Explorations2639-80282025-09-0179e128410.1097/CCE.0000000000001284202509000-00001Vasopressin Initiation Timing and In-Hospital Mortality in Septic Shock: An Observational Study of Large Public DatabasesGretchen L. Sacha, PharmD0Abhijit Duggal, MD, MPH, MSc1Anita J. Reddy, MD, MBA2Lu Wang, MS3Seth R. Bauer, PharmD41 Department of Pharmacy, Cleveland Clinic, Cleveland, OH.2 Critical Care Center, Cleveland Clinic, Cleveland, OH.2 Critical Care Center, Cleveland Clinic, Cleveland, OH.3 Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.1 Department of Pharmacy, Cleveland Clinic, Cleveland, OH.IMPORTANCE:. Vasopressin is used in one-third of patients with septic shock to augment hemodynamics and reduce overall catecholamine exposure. However, the optimal clinical context in which to initiate vasopressin is unknown. OBJECTIVES:. To determine the association between norepinephrine-equivalent dose, lactate concentration, and time duration from shock onset at vasopressin initiation with in-hospital mortality DESIGN, SETTING, AND PARTICIPANTS:. Retrospective, observational evaluation utilizing Medical Information Mart for Intensive Care-IV and electronic ICU Collaborative Research Database databases of adult patients with septic shock based on modified Sepsis-3 criteria receiving continuous infusion catecholamines. MAIN OUTCOMES AND MEASURES:. The associations of norepinephrine-equivalent dose, lactate concentration, and time duration from shock onset at vasopressin initiation with in-hospital mortality were evaluated with multivariable regression models. RESULTS:. In total, 1409 patients from 209 hospitals were included. At vasopressin initiation patients had a median (interquartile range) norepinephrine-equivalent dose 28.4 µg/min (16.4–42.6 µg/min), lactate concentration 3.7 mmol/L (2.5–6.2 mmol/L), and 5.6 hours (2.0–13.5 hr) had elapsed since shock onset. All three variables of interest were associated with in-hospital mortality. Three restricted cubic spline knots were identified where the relationship between norepinephrine-equivalent dose and in-hospital mortality changed substantially: 9, 28, and 72 µg/min. The odds of in-hospital mortality increased by 90% and 3.9-fold when comparing vasopressin initiation at norepinephrine-equivalent doses of 28 µg/min and 72 µg/min to 9 µg/min, respectively (adjusted odds ratio [OR], 1.90 [95% CI, 1.49–2.41] and 3.93 [95% CI, 2.74–5.64]). The odds of in-hospital mortality increased by 16% for every mmol/L in the lactate concentration at vasopressin initiation (adjusted OR, 1.16 [95% CI, 1.11–1.21]). Finally, the odds of in-hospital mortality increased by 3% for every hour in the time duration from shock onset to vasopressin initiation (adjusted OR, 1.03 [95% CI, 1.01–1.04]). CONCLUSIONS AND RELEVANCE:. Earlier adjunctive vasopressin initiation may decrease mortality in patients with septic shock.http://journals.lww.com/10.1097/CCE.0000000000001284 |
| spellingShingle | Gretchen L. Sacha, PharmD Abhijit Duggal, MD, MPH, MSc Anita J. Reddy, MD, MBA Lu Wang, MS Seth R. Bauer, PharmD Vasopressin Initiation Timing and In-Hospital Mortality in Septic Shock: An Observational Study of Large Public Databases Critical Care Explorations |
| title | Vasopressin Initiation Timing and In-Hospital Mortality in Septic Shock: An Observational Study of Large Public Databases |
| title_full | Vasopressin Initiation Timing and In-Hospital Mortality in Septic Shock: An Observational Study of Large Public Databases |
| title_fullStr | Vasopressin Initiation Timing and In-Hospital Mortality in Septic Shock: An Observational Study of Large Public Databases |
| title_full_unstemmed | Vasopressin Initiation Timing and In-Hospital Mortality in Septic Shock: An Observational Study of Large Public Databases |
| title_short | Vasopressin Initiation Timing and In-Hospital Mortality in Septic Shock: An Observational Study of Large Public Databases |
| title_sort | vasopressin initiation timing and in hospital mortality in septic shock an observational study of large public databases |
| url | http://journals.lww.com/10.1097/CCE.0000000000001284 |
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