Early Initiation of Vasopressin Reduces Organ Failure and Mortality in Septic Shock

Abstract

Purpose: The aim of the study is to determine whether initiating vasopressin earlier in septic shock reduces organ dysfunction and in-hospital all-cause mortality. Methods: This multicenter, retrospective, cohort study evaluated patients admitted to the medical intensive care unit between October 2011 and August 2018 with septic shock who received vasopressin within 48 hours of shock onset. The primary composite outcome was the proportion of patients with a change in the Sequential Organ Failure Assessment score greater than 3 from baseline to 72 hours after initiation of vasopressin and/or in-hospital all-cause mortality. Secondary outcomes included time to hemodynamic stability, acute kidney injury, and intensive care unit length of stay. Results: A total of 385 patients included in the final evaluation with a mean Acute Physiology and Chronic Health Evaluation II score of 31 and a mean baseline Sequential Organ Failure Assessment score of 13. Median time to initiation of vasopressin after norepinephrine was 7.3 hours. The primary composite outcome was significantly reduced in patients who had vasopressin initiated earlier in septic shock (odds ratio = 1.08, 95% confidence interval = 1.03–1.13, P < 0.001). After controlling for baseline data in a multivariable regression model the primary outcome remained statistically significant (odds ratio = 1.04, 95% confidence interval = 1.02–1.07, P = 0.001). Conclusions: Early initiation of vasopressin in septic shock may reduce the risk of in-hospital all-cause mortality and/or organ dysfunction.

Initiation Timing of Vasopressor in Patients With Septic Shock: A Systematic Review and Meta-Analysis

“…There were 10,842 retrieved articles, and 23 articles published between 2008 and 2023 that met the inclusion criteria were included (Fig. 1), involving 2 RCTs and 21 cohort studies with a total of 25,721 septic shock patients (6)(7)(8)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). The study characteristics are summarized in Table 1.…”

“…Our subgroup analysis showed the early start of vasopressin after catecholamine initiation was associated with better patient survival. There is also evidence that initiation of vasopressin at low dose of catecholamine may be better than accumulated dose (23,35,49), although this remains inconclusive even after adjusting confounding factors (25,50). Besides, some studies also suggested that the initiation of vasopressin in the early stage when patients have low lactate levels (23,35) may help identify those sensitive to vasopressin to avoid refractory shock.…”

A Systematic Review and Meta-Analysis of the Timing of Vasopressor Therapy in Patients with Septic Shock: Assessing Clinical Outcomes and Implication

“…Reardon et al [20] found no signi cant difference in mortality rate between the early and late vasopressin groups. On the other hand, Rydz and colleagues found that the in-hospital mortality was signi cantly higher in patients receiving vasopressin after 7 hours [30]. The difference between these studies may be attributed to the fact that Rydz and colleagues administered vasopressin at lower doses of norepinephrine, which might have statistically reduced the composite outcome of in-hospital mortality.…”

“…A previous meta-analysis focusing on the clinical outcomes of septic shock patients receiving early vasopressin found that patients receiving vasopressin had a reduced need for renal replacement therapy (RRT) [43]. Similarly, Rydz and colleagues reported that the incidence of AKI and the need for RRT was signi cantly lower for patients receiving adjunct vasopressin within 7 hours of stroke onset [30]. On the other hand, a previous meta-analysis focusing on the renal outcomes of distributive shock patients found that vasopressin and its analogs is associated with reduced AKI incidences and the need for RRT [45].…”

Individualizing Fluid Management in Patients with Acute Respiratory Distress Syndrome and with Reduced Lung Tissue Due to Surgery—A Narrative Review

“…Especially in the vasodilatory shock state, norepinephrine has been demonstrated to reduce the number of fluids administered to control the shock state [ 46 ]. Vasopressin seems similar to the volume expansion effect of concomitantly administered fluids [ 47 ] and may further improve hemodynamic stability and organ functions [ 48 , 49 ]. In patients with lung involvement, vasopressin improves systemic circulation seemingly without adverse effects on the pulmonary vasculature.…”