title: Racial differences in vasopressor requirements for septic shock.
abstract: OBJECTIVE
  The objective of this study was to compare vasopressor requirements between African American (AA) patients and white patients in septic shock.
  
  
  METHODS
  This was a retrospective cohort review conducted over a 2-year period measuring total and mean dosage of various vasopressors used between two racial groups during the treatment of patients admitted with septic shock. The study included patients admitted to the intensive care unit with septic shock at an 805-bed tertiary, academic center. All septic shock patients were managed with vasopressors. Vasopressor selection, dosage, and duration were at the discretion of the treating physician. Total, mean, and duration of vasopressor dosing requirements were obtained for study participants. Comorbidities, prehospitalization antihypertensive medication requirements, intravenous fluids given during the septic shock phase, and source of infection were analyzed.
  
  
  RESULTS
  One hundred fifty-nine patients with septic shock were analyzed, of which 96 (60.4%) were AAs (P < 0.059). African Americans had higher rates of end-stage renal disease and hypertension compared with whites, 85.7% vs. 14.3% (P < 0.011; odds ratio [OR], 15.684) and 68.3% vs. 31.7% (P < 0.007; OR, 3.357), respectively. Norepinephrine (NE) was administered to 150 patients, 57.2% of which were AAs (P < 0.509). Thirteen patients received dopamine (5% AAs, P < 0.588), 40 patients received phenylephrine (15.7% AAs, P < 0.451), and five patients received epinephrine (1.9% AAs, P < 0.660). Comparing vasopressors between races, only NE showed statistical significance via logistic regression modeling for the AA race in terms of total dosage (AAs 736.8 [SD, 897.3] μg vs. whites 370 [SD, 554.2] μg, P < 0.003), duration of vasopressor used (AAs 38.38 [SD, 34.75] h vs. whites 29.09 [SD, 27.11] h, P < 0.037), and mean dosage (AAs 21.08 [SD, 22.23] μg/h vs. whites 12.37 [SD, 13.86] μg/h, P < 0.01). Mortality between groups was not significant. Logistic regression identified discrepancy of the mean dose NE in AAs compared with whites, with OR of 1.043 (P = 0.01).
  
  
  CONCLUSIONS
  African American patients with septic shock were treated with higher doses of NE and required longer duration of NE administration compared with white patients.
authors.affiliation: *Department of Surgical Critical Care, Henry Ford Hospital, Detroit, Michigan; †Department of Pharmacy Services, Loyola University, Chicago, Illinois; and ‡Department of Pharmacy Services, Providence Hospital, Mobile, Alabama.
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Bauman
authors.forename: Keith F
authors.initials: KF
authors.lastname: Killu
authors.forename: Megan A
authors.initials: MA
authors.lastname: Rech
authors.forename: Jenna L
authors.initials: JL
authors.lastname: Bernabei-Combs
authors.forename: Marika Y
authors.initials: MY
authors.lastname: Gassner
authors.forename: Victor E
authors.initials: VE
authors.lastname: Coba
authors.forename: Alina
authors.initials: A
authors.lastname: Tovbin
authors.forename: Patti L
authors.initials: PL
authors.lastname: Kunkel
authors.forename: Mark E
authors.initials: ME
authors.lastname: Mlynarek
mesh_terms: D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D004305:Dose-Response Relationship, Drug; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000208:ethnology / Q000209:etiology / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000188:drug therapy / Q000208:ethnology / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012772:Shock, Septic / Q000150:complications / Q000188:drug therapy* / Q000208:ethnology / Q000503:physiopathology; D062606:Tertiary Care Centers; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*; D044465:White People
chemical_list: D014662:Vasoconstrictor Agents