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Intensity of Vasopressor Therapy as a Predictor of In-Hospital Death In Patients With Septic Shock FREE TO VIEW

Mediha Ibrahim, MD; Imnett Habtes, MD; Shweta Upadhyay; Jeffrey Berger; Patricia Patrick; Donald Brand; Peter Spiegler
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Winthrop-University Hospital, Brooklyn, NY

Chest. 2014;146(4_MeetingAbstracts):229A. doi:10.1378/chest.1992422
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SESSION TITLE: Sepsis & Septic Shock Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Septic shock is the most common cause of death in the intensive care unit, exhibiting a mortality rate of 40 to 60%. Several studies have compared mortalities associated with different vasopressors, but no study has evaluated vasopressor intensity as a prognostic indicator. In this study, therefore, we investigated the association between intensity of vasopressor therapy and in-hospital mortality in patients with septic shock.

METHODS: This retrospective cohort study included adult patients (age≥18 years) hospitalized at a community teaching hospital during 2010 with a principal or secondary diagnosis of septic shock and received one or more vasopressors. Intensity of vasopressor therapy served as the predictor variable, and in-hospital survival status served as the outcome variable. Two different measures of therapeutic intensity were considered: (1) peak number of simultaneously administered vasopressors and (2) peak vasopressor dose load (norepinephrine (mg/min) + epinephrine (mg/min) + 0.5×dopamine (mg/kg/min) + 0.1×phenylephrine (mg/min)). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) associated with various peak intensity levels were calculated for a model that predicts death in patients receiving at least the indicated peak number of pressors, i.e. ≥1 to ≥4, and the indicated peak vasopressor load, i.e. ≥1 to ≥50.

RESULTS: A total of 129 hospitalizations (128 patients) were included in these analyses. Patients were 72.5 (±15.5) years of age on average (range: 19 to 101 years); 50.0% were male. In-hospital mortality (PPV (95% CI)) by peak number of simultaneous vasopressors were as follows: ≥1, 55.0% (46.5, 63.6), ≥2, 66.7% (52.9, 78.6), ≥3, 83.3% (58.6, 96.4), and ≥4, 100% (39.8, 100). In-hospital mortality (PPV (95% CI)) by peak vasopressor load were as follows: ≥1, 55.0% (46.0, 63.8), ≥10, 61.8% (50.9, 71.9), ≥30, 77.1% (59.9, 89.6), and ≥50, 83.3% (35.9, 99.6).

CONCLUSIONS: In-hospital mortality increased as the number of simultaneous vasopressors and the peak vasopressor load increased. Preliminary analyses, therefore, suggest that these measures of vasopressor intensity may serve as tools for predicting in-hospital septic shock mortality risk; however, additional data are needed before any final conclusions can be reached.

CLINICAL IMPLICATIONS: Vasopressor intensity could assist with treatment decision-making when caring for patients with septic shock.

DISCLOSURE: The following authors have nothing to disclose: Mediha Ibrahim, Imnett Habtes, Shweta Upadhyay, Jeffrey Berger, Patricia Patrick, Donald Brand, Peter Spiegler

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