Influence of vasopressor agent in septic shock mortality. Results from the Portuguese Community-Acquired Sepsis Study (SACiUCI study).
Crit Care Med. 2009 Dec 26;
Authors: Póvoa PR, Carneiro AH, Ribeiro OS, Pereira AC,
OBJECTIVE:: Guidelines for the adrenergic support of septic shock are controversial. In patients with community-acquired septic shock, we assessed the impact of the choice of vasopressor support on mortality. DESIGN:: Cohort, multiple center, observational study. SETTING:: Seventeen Portuguese intensive care units (ICUs). PATIENTS:: All adult patients admitted to a participating ICU between December 2004 and November 2005. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Patients were followed up during the first five ICU days, the day of discharge or death, and hospital outcome. Eight hundred ninety-seven consecutive patients with community-acquired sepsis (median age, 63 years; 577 men; and hospital mortality, 38%) were studied. Of the 458 patients with septic shock, 73% received norepinephrine and 50.5% dopamine. The norepinephrine group had a higher hospital mortality (52% vs. 38.5%, p = 0.002). A Kaplan-Meier survival curve showed diminished 28-day survival in the norepinephrine group (log-rank = 22.6, p < 0.001). A Cox proportional hazard analysis revealed that the administration of norepinephrine was associated with an increased risk of death (adjusted hazard ratio, 2.501; 95% confidence interval, 1.413-4.425; p = 0.002). In a multivariate analysis with ICU mortality as the dependent factor, Simplified Acute Physiology Score II and norepinephrine administration were independent risk factors for ICU mortality in patients with septic shock. CONCLUSIONS:: In patients with community-acquired septic shock, our data suggest that norepinephrine administration could be associated with worse outcome.
PMID: 19114885 [PubMed - as supplied by publisher]