Chest
Critical Care: Research LettersThe Relationship Between Norepinephrine Equivalent Dose of Vasopressors Within 24 Hours From the Onset of Septic Shock and In-Hospital Mortality Rate
Section snippets
Methods
This was a single-center, retrospective cohort study comprised of adult patients (≥ 18 years old) with septic shock, per the definition of sepsis-3,2 who were admitted to the medical ICU in a large quaternary care hospital between January 1, 2011, and December 31, 2020. All clinical data were collected from the electronic health record. The norepinephrine equivalent (NEE) dose was calculated as previously described.3
The primary outcome was hospital mortality rate. We performed multivariable
Results
A total of 3,280 patients with septic shock (median age, 63 years old [interquartile range 54-72]; 46.1% female patients) were enrolled. Of these, 446 patients (13.6%) received NEE ≥ 1.0 μg/kg/min within the first 24 h after shock onset. The overall in-hospital mortality rate was 39.1% (1,281/3,280 patients). There were 832 patients (25.4%) who required two or more vasoactive agents in the first 24 h. The patient characteristics and outcomes are shown in Table 1. In the multivariable logistic
Discussion
In the present study, the in-hospital mortality rate dramatically and continuously increased as the maximum NEE dose in the first 24 h of shock onset increased, even after adjustment for the patient baseline characteristics and the severity score. Although the relationships between high-dose vasopressors and death have been described previously in smaller cohorts,4, 5, 6 our study is the largest cohort of patients with septic shock who condition required a maximum NEE of ≥ 1.0 μg/kg/min in the
Acknowledgments
Financial/nonfinancial disclosures: The authors have reported to CHEST the following: A. K. K. consults for Edwards Lifesciences, Medtronic, Potrero Medical, GE Healthcare, Philips North America, Caretaker Medical and Retia Medical and is funded by an NIH/NCATS KL2 award for assessment of BP and oxygenation in postoperative patients and a Wake Forest Hypertension and Vascular Research award for studying the relationship between serum renin and outcomes in patients with septic shock. A. D.
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