title: The impact of endocrine supplementation on adverse events in septic shock.
abstract: OBJECTIVE
  The objective of this study was to compare the incidence of severe adverse events of vasopressin vs hydrocortisone for endocrine support therapy in patients with septic shock.
  
  
  METHODS
  This was a retrospective, propensity-matched cohort of patients admitted to the medical intensive care unit with septic shock between February 2012 and February 2015. Patients were included if vasopressin or hydrocortisone was administered for hemodynamic support secondary to norepinephrine.
  
  
  RESULTS
  In the unmatched cohort of 124 patients, vasopressin was associated with a significant decrease in the number of severe adverse events (P=.03). In the matched cohort, severe adverse events occurred 3 times as often in patients receiving hydrocortisone; however, this difference was not statistically significant. (odds ratio, 3.33; 95% confidence interval, 0.92-12.11; P=.06). In the matched cohort, vasopressin was associated with a faster time to hemodynamic stability (P<.05) and discontinuation of hemodynamic support (P<.01) with an increased requirement for third-line therapy (P<.01). No statistical differences were seen in length of stay (intensive care unit and hospital), length of mechanical ventilation, and in-hospital mortality.
  
  
  CONCLUSIONS
  Given the lower incidence of adverse events and faster time to hemodynamic stability, vasopressin appears to be the most advantageous endocrine agent for hemodynamic support in septic shock.
authors.affiliation: Department of Pharmacy, UF Health Jacksonville, 655 West 8th St, Jacksonville, FL, 32209 USA. Electronic address: Brittany.bissell@jax.ufl.edu.
authors.forename: Brittany D
authors.initials: BD
authors.lastname: Bissell
authors.affiliation: Department of Pharmacy, UF Health Jacksonville, 655 West 8th St, Jacksonville, FL, 32209 USA. Electronic address: Michael.erdman@jax.ufl.edu.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Erdman
authors.affiliation: Center for Health Equity and Quality Research, UF College of Medicine- Jacksonville, 580 West 8th St, Jacksonville, FL, 32209 USA. Electronic address: Carmen.smotherman@jax.ufl.edu.
authors.forename: Carmen
authors.initials: C
authors.lastname: Smotherman
authors.affiliation: Center for Health Equity and Quality Research, UF College of Medicine- Jacksonville, 580 West 8th St, Jacksonville, FL, 32209 USA. Electronic address: Dale.kraemer@jax.ufl.edu.
authors.forename: Dale F
authors.initials: DF
authors.lastname: Kraemer
authors.affiliation: Department of Pharmacy, UF Health Jacksonville, 655 West 8th St, Jacksonville, FL, 32209 USA. Electronic address: Jason.ferreira@jax.ufl.edu.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Ferreira
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000368:Aged; D001127:Arginine Vasopressin / Q000008:administration & dosage; D003422:Critical Care / Q000379:methods; D004703:Endocrine System; D005260:Female; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage* / Q000097:blood; D012189:Retrospective Studies; D012772:Shock, Septic / Q000401:mortality* / Q000628:therapy*; D014667:Vasopressins / Q000008:administration & dosage*
chemical_list: D000305:Adrenal Cortex Hormones; D014667:Vasopressins; D001127:Arginine Vasopressin; D006854:Hydrocortisone; D009638:Norepinephrine
keywords: Adverse drug event; Corticosteroids; Hemodynamics; Norepinephrine; Septic shock; Vasopressin