title: Epidemiology of Vasopressin Use for Adults with Septic Shock.
abstract: Vasopressin may be used to treat vasodilatory hypotension in septic shock, but it is not recommended by guidelines as a first- or second-line agent. Little is known about how often the drug is used currently in septic shock.
  
  
  
  We conducted this study to describe patterns of vasopressin use in a large cohort of U.S. adults with septic shock and to identify patient and hospital characteristics associated with vasopressin use.
  
  
  
  This was a retrospective cohort study of adults admitted to U.S. hospitals with septic shock in the Premier healthcare database (July 2008 to June 2013). We performed multilevel mixed-effects logistic regression with hospitals as a random effect to identify factors associated with use of vasopressin alone or in combination with other vasopressors on at least 1 day of hospital admission. We calculated quotients of Akaike Information Criteria (AIC) to determine relative contributions of patient and hospital characteristics to observed variation.
  
  
  
  Among 584,421 patients with septic shock in 532 hospitals, 100,923 (17.2%) received vasopressin. A total of 6.1% of patients receiving vasopressin received vasopressin alone, and 93.9% received vasopressin in combination with other vasopressors (up to five vasopressors in 15 different combinations). The mean monthly rate of vasopressin use increased from 14.5 to 19.6% over the study period, representing an average annual relative increase of 8% (P < 0.001). The median hospital rate of vasopressin use for septic shock was 11.7% (range, 0-69.7%). Patient demographic and clinical characteristics, including patient age (adjusted odds ratio, 0.71 for age > 85 yr compared with the reference group of age < 50 yr; 95% confidence interval, 0.69-0.74) and acute respiratory dysfunction (adjusted odds ratio, 3.25; 95% confidence interval, 3.20-3.31), were responsible for the majority of observed variation in vasopressin use (quotient of AICs, 0.56). However, hospital of admission also contributed substantially to observed variation (quotient of AICs, 0.37).
  
  
  
  Approximately one-fifth of patients with septic shock received vasopressin, but rarely as a single vasopressor. The use of vasopressin has increased over time. The likelihood of receiving vasopressin was strongly associated with the specific hospital to which each patient was admitted.
authors.affiliation: 1 Department of Anesthesiology, Columbia University, New York, New York.
authors.forename: Emily A
authors.identifier: 0000-0002-1849-5780
authors.initials: EA
authors.lastname: Vail
authors.affiliation: 2 Department of Medicine, and.|3 Department of Neurology, Albert Einstein College of Medicine, New York, New York.|4 Montefiore Medical Center, New York, New York.
authors.forename: Hayley B
authors.initials: HB
authors.lastname: Gershengorn
authors.affiliation: 1 Department of Anesthesiology, Columbia University, New York, New York.
authors.forename: May
authors.initials: M
authors.lastname: Hua
authors.affiliation: 5 Boston University Department of Medicine, Boston, Massachusetts.
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Walkey
authors.affiliation: 6 University of Toronto Department of Anesthesiology, Toronto, Ontario, Canada; and.|7 Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.
authors.forename: Hannah
authors.initials: H
authors.lastname: Wunsch
mesh_terms: D000368:Aged; D016208:Databases, Factual; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007022:Hypotension / Q000188:drug therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012772:Shock, Septic / Q000150:complications*; D014481:United States; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D014667:Vasopressins / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D014667:Vasopressins
keywords: practice variation; septic shock; vasoconstrictor agents