The Association of High Dose Vasopressor and Delayed Vasopressor Titration with 28-Day Mortality in Adult Patients with Septic Shock

Authors

  • Surat Tongyoo Division of Critical Care, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
  • Tanya Tanyalakmara Division of Critical Care, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
  • Thummaporn Naorungroj Division of Critical Care, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
  • Panuwat Promsin Division of Critical Care, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
  • Chairat Permpikul Division of Critical Care, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.

DOI:

https://doi.org/10.31584/jhsmr.2022886

Keywords:

adult patients, factors, mortality, septic shock, Vasopressor dose, 28-day mortality

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.

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Published

2023-04-19

How to Cite

1.
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. J Health Sci Med Res [Internet]. 2023 Apr. 19 [cited 2024 Jul. 18];41(1):1-12. Available from: https://he01.tci-thaijo.org/index.php/jhsmr/article/view/263030

Issue

VOL 41, NO 1(2023): Jan-Feb

Section

Original Article

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