Department of Intensive Care Medicine, Inselspital, Bern Medical University, Freiburgstrasse 18, 3010 Bern, Switzerland.
Intensive Care Med. 2011 Sep;37(9):1432-7. doi: 10.1007/s00134-011-2312-3. Epub 2011 Jul 21.
To evaluate the association between concomitant arginine-vasopressin (AVP)/hydrocortisone therapy and mortality in severe septic shock patients.
This retrospective study included severe septic shock patients treated with supplementary AVP. To test the association between concomitant AVP/hydrocortisone use and mortality, a multivariate regression and Cox model (adjusted for admission year, initial AVP dosage and the Sepsis-related Organ Failure Assessment score before AVP) as well as a propensity score-based analysis were used. In both models, intensive care unit (ICU) and 28-day mortality served as outcome variables.
One hundred fifty-nine patients were included. Hydrocortisone was administered to 76 (47.8%) at a median daily dosage of 300 (200-300) mg. In the multivariate logistic regression model, concomitant use of AVP and hydrocortisone was associated with a trend towards lower ICU (OR, 0.51; CI 95%, 0.24-1.08; p = 0.08) and 28-day (HR, 0.69; CI 95%, 0.43-1.08; p = 0.11) mortality. The probability of survival at day 28, as predicted by the regression model, was significantly higher in patients treated with concomitant AVP and hydrocortisone compared to those receiving AVP without hydrocortisone (p = 0.001). In a propensity score-based analysis, ICU (45 vs. 65%; OR, 0.69; CI 95% 0.38-1.26; p = 0.23) and 28-day mortality (35.5 vs. 55%; OR, 0.59; CI 95%, 0.27-1.29; p = 0.18) was not different between patients treated with (n = 40) or without concomitant hydrocortisone (n = 40).
Concomitant AVP and hydrocortisone therapy may be associated with a survival benefit in septic shock. An adequately powered, randomised controlled trial appears warranted to confirm these preliminary, hypothesis-generating results.
评估在严重脓毒性休克患者中同时使用精氨酸加压素（AVP）/氢化可的松治疗与死亡率之间的关系。
本回顾性研究纳入了接受补充 AVP 治疗的严重脓毒性休克患者。为了检验同时使用 AVP/氢化可的松与死亡率之间的关系，采用了多变量回归和 Cox 模型（调整了入院年份、初始 AVP 剂量和使用 AVP 前的脓毒症相关器官衰竭评估评分）以及倾向评分匹配分析。在这两个模型中，重症监护病房（ICU）和 28 天死亡率均作为结局变量。
共纳入 159 例患者。76 例（47.8%）患者接受了氢化可的松治疗，其平均日剂量为 300（200-300）mg。在多变量逻辑回归模型中，同时使用 AVP 和氢化可的松与 ICU 死亡率（比值比，0.51；95%可信区间，0.24-1.08；p=0.08）和 28 天死亡率（风险比，0.69；95%可信区间，0.43-1.08；p=0.11）呈下降趋势相关。根据回归模型预测，在接受同时使用 AVP 和氢化可的松治疗的患者中，第 28 天的生存概率明显高于接受单独使用 AVP 治疗的患者（p=0.001）。在倾向评分匹配分析中，ICU 死亡率（45% vs. 65%；比值比，0.69；95%可信区间，0.38-1.26；p=0.23）和 28 天死亡率（35.5% vs. 55%；比值比，0.59；95%可信区间，0.27-1.29；p=0.18）在接受（n=40）或不接受（n=40）同时氢化可的松治疗的患者之间无差异。
同时使用 AVP 和氢化可的松治疗可能与脓毒性休克患者的生存获益相关。一项充分有力的随机对照试验似乎有必要证实这些初步的、产生假说的结果。
