PURPOSE: We previously reported using a Cumulative Vasopressor Index (CVI) score to quantitate acute hemodynamic changes associated with initiation of DTAA in patients with septic shock(1).The CVI score (range = 1-25) is an aggregate score of number and dose of all vasopressors used. PROWESS patients treated with DTAA had significant improvement in cardiovascular SOFA score over 7 days compared to placebo patients (2). We now evaluate the acute hemodynamic response to DTAA compared to placebo in a subgroup of patients from the PROWESS trial.
METHODS: We retrospectively collected hourly hemodynamic measurements from charts of patients who participated in PROWESS at our institution. The assignment (placebo or DTAA) of patients was obtained from the study sponsor after publication of results. We assigned hourly Cumulative Vasopressor Index (CVI) scores for first 24 hrs to quantify vasopressor use, and recorded both a daily CVI score, and a daily Cardiovascular SOFA score for 96 hrs.
RESULTS: 33 of 51 patients enrolled in PROWESS at our hospital had MAP< 70, and 28 patients received vasopressors (14 placebo and 14 DTAA subjects). Patients on pressors were equivalent (placebo vs. DTAA) in baseline APACHE II score, age, P/F ratio, and need for mechanical ventilation. In the first 12 hours following study drug, 8 patients (57%) treated with DTAA vs. 2 patients (14%) that received placebo had decrease in vasopressors to the lowest CVI score of 1 (p=0.046 (Fisher's Exact).
CONCLUSION: 1. A higher proportion of patients treated with DTAA for vasopressor dependent septic shock had decreased vasopressor requirements (lower CVI score) over the first 12 hours of infusion. 2. There was no statistical difference in CVI scores at 24 hours of infusion between the DTAA and placebo groups.3. The CVI score may be a method to assess the degree of hemodynamic changes in septic shock, as defined by dose and number of vasopressors used.
CLINICAL IMPLICATIONS: Further examination of larger populations with septic shock is required to address these preliminary findings.References:(1)(Thomas CCM 33 (12, Suppl.): A9)(2)(JL Vincent CCM 31(2003),pp.834-840).
DISCLOSURE: Joss Thomas, None.