The Association of High Dose Vasopressor and Delayed Vasopressor Titration with 28-Day Mortality in Adult Patients with Septic Shock
Issued Date
2023-01-01
Resource Type
ISSN
25869981
eISSN
26300559
Scopus ID
2-s2.0-85143267842
Journal Title
Journal of Health Science and Medical Research
Volume
41
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Health Science and Medical Research Vol.41 No.1 (2023)
Suggested Citation
Tongyoo S., Tanyalakmara T., Naorungroj T., Promsin P., Permpikul C. The Association of High Dose Vasopressor and Delayed Vasopressor Titration with 28-Day Mortality in Adult Patients with Septic Shock. Journal of Health Science and Medical Research Vol.41 No.1 (2023). doi:10.31584/jhsmr.2022886 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/82628
Title
The Association of High Dose Vasopressor and Delayed Vasopressor Titration with 28-Day Mortality in Adult Patients with Septic Shock
Author's Affiliation
Other Contributor(s)
Abstract
Objective: This study aimed to investigate any association between vasopressor dose and mortality, and to identify factors independently associated with 28-day mortality in adult patients with septic shock. Material and Methods: Adult septic shock patients admitted to internal medicine wards; from May 2018-November 2020, were retrospectively included. Collected data included: patient demographics and clinical characteristics, baseline vital signs, source of infection, vasopressor dose, treatment modalities and patient outcomes. The primary outcome was 28-day mortality. Results: From 253 patients, 54.9% survived, and 45.1% died. Compared to survivors, non-survivors had a significantly higher median Acute Physiology and Chronic Health Evaluation II score, higher median baseline serum lactate level and required a higher median-maximum dose of vasopressor. Multivariate analysis showed the maximum dose of vasopressor >0.2 mcg/kg/min (odd ratio (OR): 2.91, 95% confidence interval (CI): 1.13-7.47; p-value=0.027), time to maximum dose of vasopressor after 24 hours (OR: 4.98, 95% Cl: 2.07-11.99; p-value<0.001), Sequential Organ Failure Assessment score >10 (OR: 2.92, 95% CI: 1.27-6.71; p-value=0.012), pneumonia (OR: 2.16, 95 %CI: 1.01-4.61; p-value=0.047) and receiving fluid resuscitation during the first 24 hours <3,000 mL (OR: 2.27, 95% CI: 1.05-4.89; p-value=0.037) to be independent predictors of 28-day mortality. Conclusions: A higher intensity of vasopressor and longer time to maximum dose of vasopressor were found to be independent predictors of septic shock mortality.