Timing of vasopressor initiation and mortality in septic shock: a cohort study.
Timing of vasopressor initiation and mortality in septic shock: a cohort study.
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DOI：
10.1186/cc13868
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发表时间：
2014-05-12
期刊：
影响因子：
--
通讯作者：
Cooperative Antimicrobial Therapy of Septic Shock (CATSS) Database Research Group
中科院分区：
文献类型：
--
作者：
Beck V;Chateau D;Bryson GL;Pisipati A;Zanotti S;Parrillo JE;Kumar A;Cooperative Antimicrobial Therapy of Septic Shock (CATSS) Database Research Group
尽管最近在脓毒性休克的治疗方面取得了进展，但死亡率仍然高得令人无法接受。及早开始关键治疗，包括适当的抗菌素和液体复苏，似乎可以降低这种情况下的死亡率。本研究探讨了早期升压治疗是否与液体治疗难治性感染性休克患者生存率的提高有关。利用一个完善的数据库，对来自加拿大、美国和沙特阿拉伯28个icu的8670名成年患者进行了相关信息评估，包括首次记录与脓毒性休克相关的复发性/持续性低血压后给药的时间。主要终点是生存至出院。次要终点是ICU和住院时间以及呼吸机支持和血管加压药物依赖的持续时间。分析包括多元线性和逻辑回归分析。总共有8640例患者符合脓毒性休克的定义，并记录了开始使用血管加压药/肌力增强药的时间。其中，6514个适合分析。总体未调整的医院死亡率为53%。与独立死亡率相关的因素包括肝衰竭（优势比（OR） 3.46, 95%可信区间（CI） 2.67至4.48）、转移性癌症（OR 1.63, CI 1.32至2.01）、艾滋病（OR 1.91, CI 1.29至2.49）、血液恶性肿瘤（OR 1.88, CI 1.46至2.41）、中性粒细胞减少症（OR 1.78, CI 1.27至2.49）和慢性高血压（OR 0.62, CI 0.52至0.73）。延迟开始适当的抗菌治疗（OR 1.07/小时，CI 1.06至1.08）、年龄（OR 1.03/年，CI 1.02至1.03）和急性生理和慢性健康评估（APACHE） II评分（OR 1.11/点，CI 1.10至1.12）也被发现是死亡率的重要独立相关因素。调整后，血管加压药物延迟与住院死亡率之间仅存在弱相关性（调整OR 1.02/hr, 95% CI 1.01 ~ 1.03, P <0.001）。这种微弱的影响完全是由延迟时间最长的患者组（bb0 14.1小时）驱动的。存活患者的血管加压素起始延迟与血管加压素治疗持续时间无显著关系（P = 0.313），仅有延长呼吸机支持持续时间的趋势（P = 0.055）。在感染性休克患者中，血管加压剂/肌力治疗开始的明显延迟与死亡风险的小幅增加有关。
Despite recent advances in the management of septic shock, mortality remains unacceptably high. Earlier initiation of key therapies including appropriate antimicrobials and fluid resuscitation appears to reduce the mortality in this condition. This study examined whether early initiation of vasopressor therapy is associated with improved survival in fluid therapy-refractory septic shock. Utilizing a well-established database, relevant information including duration of time to vasopressor administration following the initial documentation of recurrent/persistent hypotension associated with septic shock was assessed in 8,670 adult patients from 28 ICUs in Canada, the United States of America, and Saudi Arabia. The primary endpoint was survival to hospital discharge. Secondary endpoints were length of ICU and hospital stay as well as duration of ventilator support and vasopressor dependence. Analysis involved multivariate linear and logistic regression analysis. In total, 8,640 patients met the definition of septic shock with time of vasopressor/inotropic initiation documented. Of these, 6,514 were suitable for analysis. The overall unadjusted hospital mortality rate was 53%. Independent mortality correlates included liver failure (odds ratio (OR) 3.46, 95% confidence interval (CI), 2.67 to 4.48), metastatic cancer (OR 1.63, CI, 1.32 to 2.01), AIDS (OR 1.91, CI, 1.29 to 2.49), hematologic malignancy (OR 1.88, CI, 1.46 to 2.41), neutropenia (OR 1.78, CI, 1.27 to 2.49) and chronic hypertension (OR 0.62 CI, 0.52 to 0.73). Delay of initiation of appropriate antimicrobial therapy (OR 1.07/hr, CI, 1.06 to 1.08), age (OR 1.03/yr, CI, 1.02 to 1.03), and Acute Physiology and Chronic Health Evaluation (APACHE) II Score (OR 1.11/point, CI, 1.10 to 1.12) were also found to be significant independent correlates of mortality. After adjustment, only a weak correlation between vasopressor delay and hospital mortality was found (adjusted OR 1.02/hr, 95% CI 1.01 to 1.03, P <0.001). This weak effect was entirely driven by the group of patients with the longest delays (>14.1 hours). There was no significant relationship of vasopressor initiation delay to duration of vasopressor therapy (P = 0.313) and only a trend to longer duration of ventilator support (P = 0.055) among survivors. Marked delays in initiation of vasopressor/inotropic therapy are associated with a small increase in mortality risk in patients with septic shock.
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影响因子：
2.2
作者：
Baez, Amado Alejandro;Lane, Peter L.;Giraldez, Ediza M.
通讯作者：
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影响因子：
158.5
作者：
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影响因子：
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作者：
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通讯作者：
Goyal, Munish
DOI：
10.1164/rccm.200109-016oc
发表时间：
2002-07-01
影响因子：
24.7
作者：
De Backer, D;Creteur, J;Vincent, JL
通讯作者：
Vincent, JL
影响因子：
158.5
作者：
Maitland, Kathryn;Kiguli, Sarah;Gibb, Diana M.
通讯作者：
Gibb, Diana M.