Vasopressin use in critically ill cirrhosis patients with catecholamine-resistant septic shock: The CVICU cohort

Lukasz A. Myc, Jonathan G. Stine, Rinita Chakrapani, Alexandra Kadl, Curtis K. Argo

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

AIM To examine patient-centered outcomes with vasopressin (AVP) use in patients with cirrhosis with catecholaminerefractory septic shock. METHODS We conducted a single center, retrospective cohort study enrolling adult patients with cirrhosis treated for catecholamine-resistant septic shock in the intensive care unit (ICU) from March 2011 through December 2013. Other etiologies of shock were excluded. Multivariable regression models were constructed for seven and 28-d mortality comparing AVP as a second-line therapy to a group of all other vasoactive agents. RESULTS Forty-five consecutive patients with cirrhosis were treated for catecholamine-resistant septic shock; 21 received AVP while the remaining 24 received another agent [phenylephrine (10), dopamine (6), norepinephrine (4), dobutamine (2), milrinone (2)]. In general, no significant differences in baseline demographics, etiology of cirrhosis, laboratory values, vital signs or ICU mortality/severity of illness scores were observed with the exception of higher MELD scores in the AVP group (32.4, 95%CI: 28.6-36.2 vs 27.1, 95%CI: 23.6-30.6, P = 0.041). No statistically significant difference was observed in unadjusted 7-d (52.4% AVP vs 58.3% and P = 0.408) or 28-d mortality (81.0% AVP vs 87.5% non-AVP, P = 0.371). Corticosteroid administration was associated with lower 28-d mortality (HR = 0.37, 95%CI: 0.16-0.86, P = 0.021) independent of AVP use. CONCLUSION AVP is similar in terms of patient centered outcomes of seven and 28-d mortality, in comparison to all other vasopressors when used as a second line vasoactive agent in catecholamine resistant septic shock. Large-scale prospective study would help to refine current consensus standards and provide further support to our findings.

Original languageEnglish (US)
Pages (from-to)106-113
Number of pages8
JournalWorld Journal of Hepatology
Volume9
Issue number2
DOIs
StatePublished - Jan 1 2017

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Septic Shock
Vasopressins
Critical Illness
Catecholamines
Fibrosis
Mortality
Intensive Care Units
Milrinone
Dobutamine
Vital Signs
Phenylephrine
Shock
Dopamine
Norepinephrine
Adrenal Cortex Hormones
Cohort Studies
Retrospective Studies
Demography
Prospective Studies
Therapeutics

All Science Journal Classification (ASJC) codes

  • Hepatology

Cite this

Myc, Lukasz A. ; Stine, Jonathan G. ; Chakrapani, Rinita ; Kadl, Alexandra ; Argo, Curtis K. / Vasopressin use in critically ill cirrhosis patients with catecholamine-resistant septic shock : The CVICU cohort. In: World Journal of Hepatology. 2017 ; Vol. 9, No. 2. pp. 106-113.
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title = "Vasopressin use in critically ill cirrhosis patients with catecholamine-resistant septic shock: The CVICU cohort",
abstract = "AIM To examine patient-centered outcomes with vasopressin (AVP) use in patients with cirrhosis with catecholaminerefractory septic shock. METHODS We conducted a single center, retrospective cohort study enrolling adult patients with cirrhosis treated for catecholamine-resistant septic shock in the intensive care unit (ICU) from March 2011 through December 2013. Other etiologies of shock were excluded. Multivariable regression models were constructed for seven and 28-d mortality comparing AVP as a second-line therapy to a group of all other vasoactive agents. RESULTS Forty-five consecutive patients with cirrhosis were treated for catecholamine-resistant septic shock; 21 received AVP while the remaining 24 received another agent [phenylephrine (10), dopamine (6), norepinephrine (4), dobutamine (2), milrinone (2)]. In general, no significant differences in baseline demographics, etiology of cirrhosis, laboratory values, vital signs or ICU mortality/severity of illness scores were observed with the exception of higher MELD scores in the AVP group (32.4, 95{\%}CI: 28.6-36.2 vs 27.1, 95{\%}CI: 23.6-30.6, P = 0.041). No statistically significant difference was observed in unadjusted 7-d (52.4{\%} AVP vs 58.3{\%} and P = 0.408) or 28-d mortality (81.0{\%} AVP vs 87.5{\%} non-AVP, P = 0.371). Corticosteroid administration was associated with lower 28-d mortality (HR = 0.37, 95{\%}CI: 0.16-0.86, P = 0.021) independent of AVP use. CONCLUSION AVP is similar in terms of patient centered outcomes of seven and 28-d mortality, in comparison to all other vasopressors when used as a second line vasoactive agent in catecholamine resistant septic shock. Large-scale prospective study would help to refine current consensus standards and provide further support to our findings.",
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Vasopressin use in critically ill cirrhosis patients with catecholamine-resistant septic shock : The CVICU cohort. / Myc, Lukasz A.; Stine, Jonathan G.; Chakrapani, Rinita; Kadl, Alexandra; Argo, Curtis K.

In: World Journal of Hepatology, Vol. 9, No. 2, 01.01.2017, p. 106-113.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Vasopressin use in critically ill cirrhosis patients with catecholamine-resistant septic shock

T2 - The CVICU cohort

AU - Myc, Lukasz A.

AU - Stine, Jonathan G.

AU - Chakrapani, Rinita

AU - Kadl, Alexandra

AU - Argo, Curtis K.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - AIM To examine patient-centered outcomes with vasopressin (AVP) use in patients with cirrhosis with catecholaminerefractory septic shock. METHODS We conducted a single center, retrospective cohort study enrolling adult patients with cirrhosis treated for catecholamine-resistant septic shock in the intensive care unit (ICU) from March 2011 through December 2013. Other etiologies of shock were excluded. Multivariable regression models were constructed for seven and 28-d mortality comparing AVP as a second-line therapy to a group of all other vasoactive agents. RESULTS Forty-five consecutive patients with cirrhosis were treated for catecholamine-resistant septic shock; 21 received AVP while the remaining 24 received another agent [phenylephrine (10), dopamine (6), norepinephrine (4), dobutamine (2), milrinone (2)]. In general, no significant differences in baseline demographics, etiology of cirrhosis, laboratory values, vital signs or ICU mortality/severity of illness scores were observed with the exception of higher MELD scores in the AVP group (32.4, 95%CI: 28.6-36.2 vs 27.1, 95%CI: 23.6-30.6, P = 0.041). No statistically significant difference was observed in unadjusted 7-d (52.4% AVP vs 58.3% and P = 0.408) or 28-d mortality (81.0% AVP vs 87.5% non-AVP, P = 0.371). Corticosteroid administration was associated with lower 28-d mortality (HR = 0.37, 95%CI: 0.16-0.86, P = 0.021) independent of AVP use. CONCLUSION AVP is similar in terms of patient centered outcomes of seven and 28-d mortality, in comparison to all other vasopressors when used as a second line vasoactive agent in catecholamine resistant septic shock. Large-scale prospective study would help to refine current consensus standards and provide further support to our findings.

AB - AIM To examine patient-centered outcomes with vasopressin (AVP) use in patients with cirrhosis with catecholaminerefractory septic shock. METHODS We conducted a single center, retrospective cohort study enrolling adult patients with cirrhosis treated for catecholamine-resistant septic shock in the intensive care unit (ICU) from March 2011 through December 2013. Other etiologies of shock were excluded. Multivariable regression models were constructed for seven and 28-d mortality comparing AVP as a second-line therapy to a group of all other vasoactive agents. RESULTS Forty-five consecutive patients with cirrhosis were treated for catecholamine-resistant septic shock; 21 received AVP while the remaining 24 received another agent [phenylephrine (10), dopamine (6), norepinephrine (4), dobutamine (2), milrinone (2)]. In general, no significant differences in baseline demographics, etiology of cirrhosis, laboratory values, vital signs or ICU mortality/severity of illness scores were observed with the exception of higher MELD scores in the AVP group (32.4, 95%CI: 28.6-36.2 vs 27.1, 95%CI: 23.6-30.6, P = 0.041). No statistically significant difference was observed in unadjusted 7-d (52.4% AVP vs 58.3% and P = 0.408) or 28-d mortality (81.0% AVP vs 87.5% non-AVP, P = 0.371). Corticosteroid administration was associated with lower 28-d mortality (HR = 0.37, 95%CI: 0.16-0.86, P = 0.021) independent of AVP use. CONCLUSION AVP is similar in terms of patient centered outcomes of seven and 28-d mortality, in comparison to all other vasopressors when used as a second line vasoactive agent in catecholamine resistant septic shock. Large-scale prospective study would help to refine current consensus standards and provide further support to our findings.

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