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Abstract

Introduction: Ethnic differences in adrenergic receptor density and sensitivity has been suggested to play a key role in the response to antihypertensive cardiovascular drug therapy. The impact of ethnicity for the critically ill patient requiring cardiovascular drug support has not been described. Currently in the intensive care unit (ICU), ethnicity is not considered in the management of vasopressor (VP) therapy of septic shock patients. Hypothesis: VP requirements for septic shock patients in the ICU vary between two ethnic groups: African Americans (AA) and Caucasians (CA). Methods: A retrospective cohort study conducted in an urban, academic tertiary care center. Septic shock patients admitted from October 2008 to December 2010 were evaluated. Baseline demographics included age, gender, co-morbidities, source of infection, and APACHE II scores. VP dosing, duration, and mean (using hourly dose) were collected. Univariate analysis with Chi-square, Fisher’s exact test or t-test was performed. Results: 90 of 203 patients evaluated with septic shock requiring VP support initiated in the ICU were included. 54 (60%) patients were AA and 36 (40%) were CA. There were no significant differences in baseline demographics, except end stage renal disease in AA (P=0.001). The mean APACHE II score was 19.5 ± 5.8 for AA and 19.4 ± 7.7 for CA (P=0.9). Norepinephrine was used in 89%, vasopressin 37%, phenylephrine 27%, dopamine 8% and epinephrine 4% of patients. 59% of the patients required one VP, 24% required two VP and 17% required? 3 VP. There were no statistical differences in time to goal mean arterial pressure, fluid requirements or duration of VP therapy between AA and CA.For phenylephrine, higher starting (72.7 mcg/min vs. 25.5 mcg/min, P=0.03), maximum (238.7 mcg vs. 149.5 mcg, P=0.04), and mean (171.1 mcg vs. 90.4 mcg, P=0.02) doses were required in AA compared to CA, respectively. For norepinephrine, AA required a higher mean dose (23.4 mcg/min vs. 13.6 mcg/min, P=0.03) compared to CA. Conclusions: A significant ethnic-based variation in the requirements of phenylephrine and norepinephrine was found between AA and CA septic shock patients with no significant difference in vasopressor duration or fluid requirements.