Influence of vasopressor agent in septic shock mortality. Results from the Portuguese Community-Acquired Sepsis Study (SACiUCI study).
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.


METHODS
Cohort, multiple center, observational study.


METHODS
Seventeen Portuguese intensive care units (ICUs).


METHODS
All adult patients admitted to a participating ICU between December 2004 and November 2005.


METHODS
None.


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.
Póvoa
Pedro R
PR
Medical Intensive Care Unit, São Francisco Xavier Hospital, Lisbon, Portugal. povoap@netcabo.pt
Carneiro
António H
AH
Ribeiro
Orquídea S
OS
Pereira
Altamiro C
AC
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000401:mortality; D004298:Dopamine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D011174:Portugal / Q000453:epidemiology; D016016:Proportional Hazards Models; D012772:Shock, Septic / Q000188:drug therapy* / Q000401:mortality*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D004298:Dopamine; D009638:Norepinephrine