328 Timing of Norepinephrine Administration and Mortality in Septic Shock Patients

Abstract

Septic shock still carries high mortality rate despite all advances in Emergency and critical care practices, Early interventions has been proven in many aspects to improve outcome. However, early administration of vasopressors, namely norepinephrine in septic shock, is still controversial. To identify the association between timing of norepinephrine administration and mortality rate in septic shock patients. A prospective observational study for septic shock patients in medical and surgical intensive care units for one-year period was carried out. Case definition was based on sepsis 3 definitions. Data included patients characteristics of demographics, admission diagnosis, APACHEII score, physiological data (including vital signs and laboratory values). The primary outcome was 28-days mortality. Chi-square test was used to compare categorical data and Mann-Whitney U-test to continuous data. A binary logistics regression analysis has been conducted as well to calculate the likelihood ratio between dependent variable against independent factors. 183 patients identified during the study period, 102 (58.3%) of them were males, Mean age found to be 58.9 ± 20.3. Overall rate of 28-days mortality was 87 (47.5%). The first norepinephrine was given for 68.9% of the patients in ICU; the rest were started in the emergency department. It was revealed that the lowest mortality rates among patients who received Norepinephrine within 0-0.99 (hour) (41.9%) and 1-1.99 (48.5%). And the delay till 4 hours or more was associated with the highest mortality rates (60%), followed by 2-2.99 (58.8%). A binary logistics regression analysis has been performed to ascertain the effect of mortality rate of patients against body temperature, patients intubation status, APACHE II score and creatinine level. It was revealed that patients being intubated are 3 times higher to have mortality rates as opposed to those not being intubated (OR=3.203, p-0.009). We also found out that an increase of APACHE II score is strongly associated with non-survival rates (OR=1.124, p-<0.001). Our results showed that late administration of norepinephrine in septic shock patients is associated with higher mortality rate compared to early administration.