title: Vasopressin use is associated with death in acute trauma patients with shock.
abstract: OBJECTIVE
  Traumatic hemodynamic instability is associated with high mortality if not expeditiously corrected. Hypotension despite adequate volume resuscitation is treated with vasopressors. Although catecholamines are typically the first agent used, arginine vasopressin (AVP) is increasingly been used as an adjuvant agent. Mortality with refractory hypotension and vasopressin use in trauma patients is unknown.
  
  
  METHODS
  A retrospective cohort analysis of trauma patients requiring vasopressors within 72 hours of admission was performed. Two groups were identified: patients who received AVP (AVP+) and those who did not (AVP-). Primary outcome was mortality.
  
  
  RESULTS
  Five hundred thirty nine patients met the criteria with 189 patients receiving AVP. Demographics, Injury Severity Score, minimum hemoglobin, and blood volume resuscitation (packed red blood cell, fresh frozen plasma, and platelets) were similar between groups. Trauma and Injury Severity Score suggested a higher probability of survival in AVP+ (0.88 vs 0.73, P < .001); however, the observed mortality was higher (55% vs 41%, P = .002). The age, Injury Severity Score, initial lactate, and severe head injury adjusted odds ratio of death for AVP+ patients was 1.6 (95% confidence interval, 1.1-2.4; P = .02).
  
  
  CONCLUSIONS
  Arginine vasopressin is associated with increased mortality in trauma patients with refractory hypotension. Arginine vasopressin may be a marker of illness or possibly play a causal role in adverse outcomes. Clinicians should reconsider expanding the indications of AVP use.
authors.affiliation: Division of Trauma and Surgical Critical Care, The Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA. bryan.collier@vanderbilt.edu
authors.forename: Bryan
authors.initials: B
authors.lastname: Collier
authors.forename: Lesly
authors.initials: L
authors.lastname: Dossett
authors.forename: Mindy
authors.initials: M
authors.lastname: Mann
authors.forename: Bryan
authors.initials: B
authors.lastname: Cotton
authors.forename: Oscar
authors.initials: O
authors.lastname: Guillamondegui
authors.forename: Jose
authors.initials: J
authors.lastname: Diaz
authors.forename: Sloan
authors.initials: S
authors.lastname: Fleming
authors.forename: Addison
authors.initials: A
authors.lastname: May
authors.forename: John
authors.initials: J
authors.lastname: Morris
mesh_terms: D000208:Acute Disease; D000328:Adult; D001127:Arginine Vasopressin / Q000009:adverse effects* / Q000627:therapeutic use; D002395:Catecholamines / Q000008:administration & dosage; D015331:Cohort Studies; D003422:Critical Care; D004359:Drug Therapy, Combination; D005260:Female; D005440:Fluid Therapy; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000188:drug therapy*; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012774:Shock, Traumatic / Q000188:drug therapy* / Q000401:mortality*; D014662:Vasoconstrictor Agents / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D002395:Catecholamines; D014662:Vasoconstrictor Agents; D001127:Arginine Vasopressin