title: Does high-dose vasopressor therapy in medical intensive care patients indicate what we already suspect?
abstract: OBJECTIVE
  This study was conducted to determine the association between vasopressor requirement and outcome in medical intensive care patients in an environment where treatment is not withdrawn.
  
  
  METHODS
  This was an observational study of patients in the medical intensive care unit (ICU) over a period of 18 months to determine the correlation between vasopressor requirement and mortality. Outcome was determined for all medical ICU patients, for patients receiving "low dose" (<40 μg/min) vasopressors (noradrenaline and/or adrenaline) or "high dose" (≥ 40 μg/min) vasopressors. Receiver operator characteristic curves were constructed for ICU and hospital mortality and high-dose vasopressor use. High-dose vasopressor use as an independent predictor for ICU and hospital mortality was also determined by multiple logistic regression analysis.
  
  
  RESULTS
  Patients receiving high-dose noradrenaline at any time during their ICU admission had an 84.3% mortality in ICU and 90% in hospital. The receiver operator characteristic curves for high-dose vasopressors had an area under the curve of 0.799 for ICU mortality and 0.779 for hospital mortality. High-dose vasopressor was an independent predictor of ICU mortality, with an odds ratio of 5.1 (confidence interval, 2.02-12.9; P = .001), and of hospital mortality, with an odds ratio of 3.82 (confidence interval 1.28-11.37; P = .016).
  
  
  CONCLUSIONS
  The requirement for high-dose vasopressor therapy at any time during ICU admission was associated with a very high mortality rate in the ICU and the hospital.
authors.affiliation: Medical Intensive Care Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Sviri
authors.affiliation: Medical Intensive Care Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: J
authors.initials: J
authors.lastname: Hashoul
authors.affiliation: Medical Intensive Care Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: I
authors.initials: I
authors.lastname: Stav
authors.affiliation: Medical Intensive Care Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Electronic address: Vernon@hadassah.org.il.
authors.forename: P V
authors.initials: PV
authors.lastname: van Heerden
mesh_terms: D018806:APACHE; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010361:Patients; D012372:ROC Curve; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
chemical_list: D014662:Vasoconstrictor Agents
keywords: ICU outcome; Mortality; Vasopressors