title: Vasopressin use in critically ill cirrhosis patients with catecholamine-resistant septic shock: The CVICU cohort.
abstract: OBJECTIVE
  To examine patient-centered outcomes with vasopressin (AVP) use in patients with cirrhosis with catecholamine-refractory septic shock.
  
  
  METHODS
  We conducted a single center, retrospective cohort study enrolling adult patients with cirrhosis treated for catecholamine-resistant septic shock in the intensive care unit (ICU) from March 2011 through December 2013. Other etiologies of shock were excluded. Multivariable regression models were constructed for seven and 28-d mortality comparing AVP as a second-line therapy to a group of all other vasoactive agents.
  
  
  RESULTS
  Forty-five consecutive patients with cirrhosis were treated for catecholamine-resistant septic shock; 21 received AVP while the remaining 24 received another agent [phenylephrine (10), dopamine (6), norepinephrine (4), dobutamine (2), milrinone (2)]. In general, no significant differences in baseline demographics, etiology of cirrhosis, laboratory values, vital signs or ICU mortality/severity of illness scores were observed with the exception of higher MELD scores in the AVP group (32.4, 95%CI: 28.6-36.2vs27.1, 95%CI: 23.6-30.6,P= 0.041). No statistically significant difference was observed in unadjusted 7-d (52.4% AVPvs58.3% andP= 0.408) or 28-d mortality (81.0% AVPvs87.5% non-AVP,P= 0.371). Corticosteroid administration was associated with lower 28-d mortality (HR = 0.37, 95%CI: 0.16-0.86,P= 0.021) independent of AVP use.
  
  
  CONCLUSIONS
  AVP is similar in terms of patient centered outcomes of seven and 28-d mortality, in comparison to all other vasopressors when used as a second line vasoactive agent in catecholamine resistant septic shock. Large-scale prospective study would help to refine current consensus standards and provide further support to our findings.
authors.affiliation: Lukasz A Myc, Department of Medicine, University of Virginia, Charlottesville, VA 22908, United States.
authors.forename: Lukasz A
authors.initials: LA
authors.lastname: Myc
authors.affiliation: Lukasz A Myc, Department of Medicine, University of Virginia, Charlottesville, VA 22908, United States.
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Stine
authors.affiliation: Lukasz A Myc, Department of Medicine, University of Virginia, Charlottesville, VA 22908, United States.
authors.forename: Rinita
authors.initials: R
authors.lastname: Chakrapani
authors.affiliation: Lukasz A Myc, Department of Medicine, University of Virginia, Charlottesville, VA 22908, United States.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Kadl
authors.affiliation: Lukasz A Myc, Department of Medicine, University of Virginia, Charlottesville, VA 22908, United States.
authors.forename: Curtis K
authors.initials: CK
authors.lastname: Argo
keywords: Hepatology; Intensive care unit; Liver; Portal hypertension; Vasopressor