Influence of vasopressor agent in septic shock mortality. Results from the Portuguese Community-Acquired Sepsis Study (SACiUCI study)
Influence of vasopressor agent in septic shock mortality. Results from the Portuguese Community-Acquired Sepsis Study (SACiUCI study)
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DOI：
10.1097/ccm.0b013e3181958b1c
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发表时间：
2009-02-01
影响因子：
8.8
通讯作者：
Pereira, Altamiro C.
中科院分区：
文献类型：
--
作者：
Povoa, Pedro R.;Carneiro, Antonio H.;Pereira, Altamiro C.
目的：脓毒性休克的肾上腺素能支持指南存在争议。在社区获得性感染性休克患者中，我们评估了血管加压剂支持的选择对死亡率的影响。队列、多中心、观察性研究。环境：17个葡萄牙重症监护病房（icu）。所有在2004年12月至2005年11月间入住ICU的成年患者。干预措施:没有。测量方法和主要结果：患者在ICU的前5天、出院或死亡当天以及医院结果进行随访。研究了897例连续的社区获得性败血症患者（中位年龄63岁，男性577例，住院死亡率38%）。458例脓毒性休克患者中，73%接受去甲肾上腺素和50.5%多巴胺治疗。去甲肾上腺素组的住院死亡率更高（52% vs. 38.5%, p = 0.002）。Kaplan-Meier生存曲线显示去甲肾上腺素组28天生存率降低（log-rank = 22.6, p < 0.001）。Cox比例风险分析显示，给药去甲肾上腺素与死亡风险增加相关（校正风险比为2.501；95%可信区间为1.413-4.425;p = 0.002）。在以ICU死亡率为依赖因素的多因素分析中，简化急性生理评分II和去甲肾上腺素给药是脓毒性休克患者ICU死亡率的独立危险因素。结论：在社区获得性感染性休克患者中，我们的数据表明，去甲肾上腺素的使用可能与较差的预后相关。（重症护理医学2009；37:410-416）
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 norepirephrine 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. (Crit Care Med 2009; 37: 410-416)