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Research
Michele McCloskey
Barnes-Jewish Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-2407-4237
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Background: New-onset arrhythmias (NOA) are common in sepsis and septic shock and associated with poor clinical outcomes. Reduced exposure to catecholamines via early initiation of non-catecholamine vasoactive agents (e.g. vasopressin) may represent a means of reducing the incidence of NOA.
Methods: An 8-year retrospective, observational cohort study was conducted including medical and surgical intensive care unit (ICU) patients with septic shock and no history of cardiac arrhythmias who received norepinephrine and vasopressin. Early administration was defined as receipt of vasopressin within six hours of septic shock onset. Univariable analyses were used to compare groups and a multivariable logistic regression performed to identify potential predictors of NOA. Time-to-event analyses were expressed using the Kaplan-Meier method with differences assessed via log-rank test.
Results: 220 patients were included in the early vasopressin group and 216 in the late vasopressin group. Similar rates of comorbid and disease severity burden were observed between groups. Compared to the late vasopressin group, early vasopressin initiation was not associated with a lower incidence of NOA (9 vs 7%; p = 0.41). Early vasopressin initiation was associated with shorter median duration of shock (2 vs 4 days; p < 0.001), duration of norepinephrine administration (41 vs 80 hours; p < 0.001), ICU length of stay (6 vs 7 days; p = 0.02) and in-hospital mortality (41 vs 59%; p < 0.001). Multivariable logistic regression did not identify any significant predictors of NOA.
Conclusions: Administering vasopressin within six hours of the onset of septic shock was not associated with a lower incidence of NOA. Future, prospective studies are needed to further elucidate the role of vasopressin timing on NOA and other clinical outcomes.
Keywords
septic shock, vasopressin, arrhythmia, timing, administration
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This is a preprint. It has not completed peer review.
Research
Michele McCloskey
Barnes-Jewish Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-2407-4237
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 25 Mar, 2021
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Critical Care & Emergency Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: New-onset arrhythmias (NOA) are common in sepsis and septic shock and associated with poor clinical outcomes. Reduced exposure to catecholamines via early initiation of non-catecholamine vasoactive agents (e.g. vasopressin) may represent a means of reducing the incidence of NOA.
Methods: An 8-year retrospective, observational cohort study was conducted including medical and surgical intensive care unit (ICU) patients with septic shock and no history of cardiac arrhythmias who received norepinephrine and vasopressin. Early administration was defined as receipt of vasopressin within six hours of septic shock onset. Univariable analyses were used to compare groups and a multivariable logistic regression performed to identify potential predictors of NOA. Time-to-event analyses were expressed using the Kaplan-Meier method with differences assessed via log-rank test.
Results: 220 patients were included in the early vasopressin group and 216 in the late vasopressin group. Similar rates of comorbid and disease severity burden were observed between groups. Compared to the late vasopressin group, early vasopressin initiation was not associated with a lower incidence of NOA (9 vs 7%; p = 0.41). Early vasopressin initiation was associated with shorter median duration of shock (2 vs 4 days; p < 0.001), duration of norepinephrine administration (41 vs 80 hours; p < 0.001), ICU length of stay (6 vs 7 days; p = 0.02) and in-hospital mortality (41 vs 59%; p < 0.001). Multivariable logistic regression did not identify any significant predictors of NOA.
Conclusions: Administering vasopressin within six hours of the onset of septic shock was not associated with a lower incidence of NOA. Future, prospective studies are needed to further elucidate the role of vasopressin timing on NOA and other clinical outcomes.
Figure 1
Figure 2
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