Epidemiology of Vasopressin Use for Adults with Septic Shock.
Ann Am Thorac Soc. 2016 Jul 12;
Authors: Vail EA, Gershengorn HB, Hua M, Walkey AJ, Wunsch H
Abstract
RATIONALE: Vasopressin may be used to treat vasodilatory hypotension in septic shock, but it is not recommended by guidelines as a first or second-line agent. Little is known about how often the drug is used currently in septic shock.
OBJECTIVES: We conducted this study to describe patterns of vasopressin use in a large cohort of US adults with septic shock and to identify patient and hospital characteristics associated with vasopressin use.
METHODS: Retrospective cohort study of adults admitted to US hospitals with septic shock in the Premier healthcare database (July 2008 - June 2013). We performed multilevel mixed-effects logistic regression with hospitals as a random effect to identify factors associated with use of vasopressin alone or in combination with other vasopressors, on at least one day of hospital admission. We calculated quotients of Akaike Information Criteria (AIC) to determine relative contributions of patient and hospital characteristics to observed variation.
MEASUREMENTS AND MAIN RESULTS: Among 584,421 patients with septic shock in 532 hospitals, 100,923 (17.2%) received vasopressin. 6.1% of patients receiving vasopressin received vasopressin alone, and 93.9% received vasopressin in combination with other vasopressors (up to 5 vasopressors in 15 different combinations). The mean monthly rate of vasopressin use increased from 14.5% to 19.6% over the study period, representing an average annual relative increase of 8% (p<0.001). The median hospital rate of vasopressin use during septic shock was 11.7% (range 0 to 69.7%). Patient demographic and clinical characteristics, including patient age (aOR 0.71 for age greater than 85 years compared to the reference group of age less than 50 years, 95% CI 0.69-0.74) and acute respiratory dysfunction (aOR 3.25, 95% CI 3.20 - 3.31) were responsible for the majority of observed variation in vasopressin use (quotient of AICs 0.56). However, hospital of admission also contributed substantially to observed variation (quotient of AICs 0.37).
CONCLUSIONS: Approximately one fifth of patients with septic shock received vasopressin, but rarely as a single vasopressor. The use of vasopressin has increased over time. The likelihood of receiving vasopressin was strongly associated with the specific hospital to which each patient was admitted.
PMID: 27404213 [PubMed - as supplied by publisher]