title: Concomitant arginine-vasopressin and hydrocortisone therapy in severe septic shock: association with mortality.
abstract: OBJECTIVE
  To evaluate the association between concomitant arginine-vasopressin (AVP)/hydrocortisone therapy and mortality in severe septic shock patients.
  
  
  METHODS
  This retrospective study included severe septic shock patients treated with supplementary AVP. To test the association between concomitant AVP/hydrocortisone use and mortality, a multivariate regression and Cox model (adjusted for admission year, initial AVP dosage and the Sepsis-related Organ Failure Assessment score before AVP) as well as a propensity score-based analysis were used. In both models, intensive care unit (ICU) and 28-day mortality served as outcome variables.
  
  
  RESULTS
  One hundred fifty-nine patients were included. Hydrocortisone was administered to 76 (47.8%) at a median daily dosage of 300 (200-300) mg. In the multivariate logistic regression model, concomitant use of AVP and hydrocortisone was associated with a trend towards lower ICU (OR, 0.51; CI 95%, 0.24-1.08; p = 0.08) and 28-day (HR, 0.69; CI 95%, 0.43-1.08; p = 0.11) mortality. The probability of survival at day 28, as predicted by the regression model, was significantly higher in patients treated with concomitant AVP and hydrocortisone compared to those receiving AVP without hydrocortisone (p = 0.001). In a propensity score-based analysis, ICU (45 vs. 65%; OR, 0.69; CI 95% 0.38-1.26; p = 0.23) and 28-day mortality (35.5 vs. 55%; OR, 0.59; CI 95%, 0.27-1.29; p = 0.18) was not different between patients treated with (n = 40) or without concomitant hydrocortisone (n = 40).
  
  
  CONCLUSIONS
  Concomitant AVP and hydrocortisone therapy may be associated with a survival benefit in septic shock. An adequately powered, randomised controlled trial appears warranted to confirm these preliminary, hypothesis-generating results.
authors.affiliation: Department of Intensive Care Medicine, Inselspital, Bern Medical University, Freiburgstrasse 18, 3010 Bern, Switzerland. Christian-Erik.Torgersen@insel.ch
authors.forename: Christian
authors.initials: C
authors.lastname: Torgersen
authors.forename: Günter
authors.initials: G
authors.lastname: Luckner
authors.forename: Daniel C H
authors.initials: DC
authors.lastname: Schröder
authors.forename: Christian A
authors.initials: CA
authors.lastname: Schmittinger
authors.forename: Christopher
authors.initials: C
authors.lastname: Rex
authors.forename: Hanno
authors.initials: H
authors.lastname: Ulmer
authors.forename: Martin W
authors.initials: MW
authors.lastname: Dünser
mesh_terms: D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001127:Arginine Vasopressin / Q000008:administration & dosage / Q000627:therapeutic use*; D001317:Austria / Q000453:epidemiology; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D006490:Hemostatics / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000627:therapeutic use*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012772:Shock, Septic / Q000188:drug therapy* / Q000401:mortality*
chemical_list: D000893:Anti-Inflammatory Agents; D006490:Hemostatics; D001127:Arginine Vasopressin; D006854:Hydrocortisone