1213: A COMPARISON OF CORTICOSTEROIDS VERSUS VASOPRESSIN AS A SECOND-LINE ADD-ON AGENT IN SEPTIC SHOCK

Abstract

Introduction: First-line hemodynamic support and the vasopressor of choice for septic shock is norepinephrine. There is considerable variability in practice and a paucity of data regarding when to add vasopressin or corticosteroids, and in what sequence. Defining which agent to administer secondarily to norepinephrine for escalation of hemodynamic support could reduce unnecessary adverse events from central line utilization, decrease adverse drug events, and may result in more economic management of patients. Methods: This is a single-center, retrospective cohort study of patients admitted to the intensive care unit (ICU) between October 2020 and January 2021. Patients were included if > 18 years of age and received norepinephrine plus either vasopressin or corticosteroids as second-line support for septic shock. Patients were excluded if they were on corticosteroids prior to admission. The primary outcome was the percentage of patients who required escalation of hemodynamic support after receipt of a second-line agent within 2 hours. Secondary outcomes included ICU length of stay (LOS), hospital LOS, in-hospital mortality, total hours on vasopressors, acute kidney injury (AKI), need for dialysis and/or renal replacement therapy, superinfection > 48 hours from time zero, and central line utilization. Results: Of 1287 patients screened for inclusion, 142 patients were included in the primary analysis. Eighty-three patients received vasopressin first, 43 patients received corticosteroids first, and 13 patients received both vasopressin and corticosteroids at the same time. For the primary outcome, 15.7%, 32.6%, 7.7% required escalation of norepinephrine within 2 hours, respectively. Respectively, mortality rates were 62.7%, 65.1%, and 76.9%. Central line utilization was on average 12.5 days, 6.6 days, and 5 days among the respective groups. Conclusions: There exists a lack of data when examining the utilization of vasopressin and corticosteroids as second-line add-on agents in septic shock. There was a higher mortality rate than expected among the population who received both corticosteroids and vasopressin at the same time. Central line utilization was lower in those who received corticosteroids first and for those who received both at the same time.