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. 2023 Mar;38(3):273-279.
doi: 10.1177/08850666221118282. Epub 2022 Sep 4.

Vasopressin Response and Clinical Trajectory in Septic Shock Patients

Seth R Bauer  1   2 , Gretchen L Sacha  1 , Matthew T Siuba  2   3 , Lu Wang  1   4 , Xiaofeng Wang  2   4 , Rachel G Scheraga  2   3   5 , Vidula Vachharajani  2   3   5
Affiliations

Vasopressin Response and Clinical Trajectory in Septic Shock Patients

Seth R Bauer et al. J Intensive Care Med. 2023 Mar.

Abstract

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.

Keywords: chronic critical illness; clinical trajectory; sepsis; septic shock; vasoconstrictor agents; vasopressin.

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Conflict of interest statement

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.

Figures

Figure 1.
Figure 1.. A to D.
Clinical Trajectories, Composite Endpoint Score, and Mortality by Vasopressin Response and Admission Type. A, Proportion vasopressin response. Composite endpoint scores ranged between 0 and 38, with higher values reflecting a better outcome. C, Kaplan-Meier curves for 28-day mortality by vasopressin response. Vasopressin response multivariable-adjusted hazard ratio 0.60 (95% CI 0.49–0.75). D, Proportion within medical (N = 773) and surgical (N = 165) admission types who developed each clinical trajectory. CCI = chronic critical illness. within vasopressin non-responders versus responders who developed each clinical trajectory. B, Histogram of composite endpoint score by
See this image and copyright information in PMC

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