Timing of vasopressor initiation and mortality in septic shock: a cohort study

Beck, Vance; Chateau, Dan; Bryson, Gregory L; Pisipati, Amarnath; Zanotti, Sergio; Parrillo, Joseph E; Kumar, Anand; The Cooperative Antimicrobial Therapy of Septic Shock (CATSS) Database Research Group

Timing of vasopressor initiation and mortality in septic shock: a cohort study

dc.contributor.author	Beck, Vance
dc.contributor.author	Chateau, Dan
dc.contributor.author	Bryson, Gregory L
dc.contributor.author	Pisipati, Amarnath
dc.contributor.author	Zanotti, Sergio
dc.contributor.author	Parrillo, Joseph E
dc.contributor.author	Kumar, Anand
dc.contributor.author	The Cooperative Antimicrobial Therapy of Septic Shock (CATSS) Database Research Group
dc.date.accessioned	2014-06-16T19:03:54Z
dc.date.available	2014-06-16T19:03:54Z
dc.date.issued	2014-05-12
dc.date.updated	2014-06-16T19:03:55Z
dc.description.abstract	Abstract Introduction Despite recent advances in the management of septic shock, mortality remains unacceptably high. Earlier initiation of key therapies including appropriate antimicrobials and fluid resuscitation appears to reduce the mortality in this condition. This study examined whether early initiation of vasopressor therapy is associated with improved survival in fluid therapy-refractory septic shock. Methods Utilizing a well-established database, relevant information including duration of time to vasopressor administration following the initial documentation of recurrent/persistent hypotension associated with septic shock was assessed in 8,670 adult patients from 28 ICUs in Canada, the United States of America, and Saudi Arabia. The primary endpoint was survival to hospital discharge. Secondary endpoints were length of ICU and hospital stay as well as duration of ventilator support and vasopressor dependence. Analysis involved multivariate linear and logistic regression analysis. Results In total, 8,640 patients met the definition of septic shock with time of vasopressor/inotropic initiation documented. Of these, 6,514 were suitable for analysis. The overall unadjusted hospital mortality rate was 53%. Independent mortality correlates included liver failure (odds ratio (OR) 3.46, 95% confidence interval (CI), 2.67 to 4.48), metastatic cancer (OR 1.63, CI, 1.32 to 2.01), AIDS (OR 1.91, CI, 1.29 to 2.49), hematologic malignancy (OR 1.88, CI, 1.46 to 2.41), neutropenia (OR 1.78, CI, 1.27 to 2.49) and chronic hypertension (OR 0.62 CI, 0.52 to 0.73). Delay of initiation of appropriate antimicrobial therapy (OR 1.07/hr, CI, 1.06 to 1.08), age (OR 1.03/yr, CI, 1.02 to 1.03), and Acute Physiology and Chronic Health Evaluation (APACHE) II Score (OR 1.11/point, CI, 1.10 to 1.12) were also found to be significant independent correlates of mortality. After adjustment, only a weak correlation between vasopressor delay and hospital mortality was found (adjusted OR 1.02/hr, 95% CI 1.01 to 1.03, P <0.001). This weak effect was entirely driven by the group of patients with the longest delays (>14.1 hours). There was no significant relationship of vasopressor initiation delay to duration of vasopressor therapy (P = 0.313) and only a trend to longer duration of ventilator support (P = 0.055) among survivors. Conclusion Marked delays in initiation of vasopressor/inotropic therapy are associated with a small increase in mortality risk in patients with septic shock.
dc.description.version	Peer Reviewed
dc.identifier.citation	Critical Care. 2014 May 12;18(3):R97
dc.identifier.doi	http://dx.doi.org/10.1186/cc13868
dc.identifier.uri	http://hdl.handle.net/1993/23630
dc.language.rfc3066	en
dc.rights	open access	en_US
dc.rights.holder	Vance Beck et al.; licensee BioMed Central Ltd.
dc.title	Timing of vasopressor initiation and mortality in septic shock: a cohort study
dc.type	Journal Article