PMID- 36062611 OWN - NLM STAT- MEDLINE DCOM- 20221228 LR - 20240302 IS - 1525-1489 (Electronic) IS - 0885-0666 (Print) IS - 0885-0666 (Linking) VI - 38 IP - 3 DP - 2023 Mar TI - Vasopressin Response and Clinical Trajectory in Septic Shock Patients. PG - 273-279 LID - 10.1177/08850666221118282 [doi] AB - BACKGROUND: In septic shock, vasopressors aim to improve tissue perfusion and prevent persistent organ dysfunction, a characteristic of chronic critical illness (CCI). Adjunctive vasopressin is often used to decrease catecholamine dosage, but the association of vasopressin response with subsequent patient outcomes is unclear. We hypothesized vasopressin response is associated with favorable clinical trajectory. METHODS: We included patients with septic shock receiving vasopressin as a catecholamine adjunct in this retrospective cohort study. We defined vasopressin response as a lowering of the catecholamine dose required to maintain mean arterial pressure >/=65 mm Hg, 6 h after vasopressin initiation. Clinical trajectories were adjudicated as early death (ED; death before day 14), CCI (ICU stay >/=14 days with persistent organ dysfunction), or rapid recovery (RR; not meeting ED or CCI criteria). Trajectories were placed on an ordinal scale with ED the worst outcome, CCI next, and RR the best outcome. The association of vasopressin response with clinical trajectory was assessed with multivariable ordinal logistic regression. RESULTS: In total 938 patients were included; 426 (45.4%) were vasopressin responders. The most frequent trajectory was ED (49.8%), 29.7% developed CCI, and 20.5% had rapid recovery. In survivors to ICU day 14 (those without ED), 59.2% had CCI and 40.8% experienced RR. Compared with vasopressin non-responders, vasopressin responders less frequently experienced ED (42.5% vs. 55.9%) and more frequently experienced RR (24.6% vs. 17.0%; P < 0.01). After controlling for confounders, vasopressin response was independently associated with higher odds of developing a better clinical trajectory (OR 1.63; 95% CI 1.26-2.10). Medical patients most frequently developed ED and survivors more commonly developed CCI than RR; surgical patients developed the three trajectories with similar frequency (P < 0.01). CONCLUSIONS: Vasopressin responsive status was associated with improved clinical trajectory in septic shock patients. Early vasopressin response is a potential novel prognostic marker for short-term clinical trajectory. FAU - Bauer, Seth R AU - Bauer SR AUID- ORCID: 0000-0002-0420-0320 AD - Department of Pharmacy, 2569Cleveland Clinic, Cleveland, OH, USA. AD - Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA. FAU - Sacha, Gretchen L AU - Sacha GL AUID- ORCID: 0000-0002-0070-8100 AD - Department of Pharmacy, 2569Cleveland Clinic, Cleveland, OH, USA. FAU - Siuba, Matthew T AU - Siuba MT AD - Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA. AD - Department of Critical Care Medicine, Respiratory Institute, 2569Cleveland Clinic, Cleveland, OH, USA. FAU - Wang, Lu AU - Wang L AD - Department of Pharmacy, 2569Cleveland Clinic, Cleveland, OH, USA. AD - Department of Quantitative Health Sciences, Lerner Research Institute, 2569Cleveland Clinic, Cleveland, OH, USA. FAU - Wang, Xiaofeng AU - Wang X AD - Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA. AD - Department of Quantitative Health Sciences, Lerner Research Institute, 2569Cleveland Clinic, Cleveland, OH, USA. FAU - Scheraga, Rachel G AU - Scheraga RG AD - Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA. AD - Department of Critical Care Medicine, Respiratory Institute, 2569Cleveland Clinic, Cleveland, OH, USA. AD - Department of Inflammation and Immunity, Lerner Research Institute, 2569Cleveland Clinic, Cleveland, OH, USA. FAU - Vachharajani, Vidula AU - Vachharajani V AD - Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA. AD - Department of Critical Care Medicine, Respiratory Institute, 2569Cleveland Clinic, Cleveland, OH, USA. AD - Department of Inflammation and Immunity, Lerner Research Institute, 2569Cleveland Clinic, Cleveland, OH, USA. LA - eng GR - K08 GM147806/GM/NIGMS NIH HHS/United States GR - R01 GM099807/GM/NIGMS NIH HHS/United States GR - R01 HL155064/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20220904 PL - United States TA - J Intensive Care Med JT - Journal of intensive care medicine JID - 8610344 RN - 11000-17-2 (Vasopressins) RN - 0 (Vasoconstrictor Agents) RN - 0 (Catecholamines) SB - IM MH - Humans MH - *Shock, Septic/drug therapy MH - Retrospective Studies MH - Multiple Organ Failure MH - Vasopressins/therapeutic use MH - Vasoconstrictor Agents/therapeutic use MH - Catecholamines MH - Critical Illness PMC - PMC10236982 MID - NIHMS1838224 OTO - NOTNLM OT - chronic critical illness OT - clinical trajectory OT - sepsis OT - septic shock OT - vasoconstrictor agents OT - vasopressin COIS- Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. EDAT- 2022/09/06 06:00 MHDA- 2022/12/29 06:00 PMCR- 2024/03/01 CRDT- 2022/09/05 06:23 PHST- 2022/09/06 06:00 [pubmed] PHST- 2022/12/29 06:00 [medline] PHST- 2022/09/05 06:23 [entrez] PHST- 2024/03/01 00:00 [pmc-release] AID - 10.1177/08850666221118282 [doi] PST - ppublish SO - J Intensive Care Med. 2023 Mar;38(3):273-279. doi: 10.1177/08850666221118282. Epub 2022 Sep 4.