The Association of High Dose Vasopressor and Delayed Vasopressor Titration with 28-Day Mortality in Adult Patients with Septic Shock

Abstract

Objective: This study aimed to investigate any association between vasopressor dose and mortality, and to identify factors independently associated with 28-day mortality in adult patients with septic shock. Material and Methods: Adult septic shock patients admitted to internal medicine wards; from May 2018-November 2020, were retrospectively included. Collected data included: patient demographics and clinical characteristics, baseline vital signs, source of infection, vasopressor dose, treatment modalities and patient outcomes. The primary outcome was 28-day mortality. Results: From 253 patients, 54.9% survived, and 45.1% died. Compared to survivors, non-survivors had a significantly higher median Acute Physiology and Chronic Health Evaluation II score, higher median baseline serum lactate level and required a higher median-maximum dose of vasopressor. Multivariate analysis showed the maximum dose of vasopressor >0.2 mcg/kg/min (odd ratio (OR): 2.91, 95% confidence interval (CI): 1.13-7.47; p-value=0.027), time to maximum dose of vasopressor after 24 hours (OR: 4.98, 95%Cl: 2.07-11.99; p-value<0.001), Sequential Organ Failure Assessment score >10 (OR: 2.92, 95%CI: 1.27-6.71; p-value=0.012), pneumonia (OR: 2.16, 95%CI: 1.01-4.61; p-value=0.047) and receiving fluid resuscitation during the first 24 hours <3,000 mL (OR: 2.27, 95%CI: 1.05-4.89; p-value=0.037) to be independent predictors of 28-day mortality. Conclusions: A higher intensity of vasopressor and longer time to maximum dose of vasopressor were found to be independent predictors of septic shock mortality.