Department of Anaesthesia and Critical Care, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Anaesthesia. 2021 Oct;76(10):1358-1366. doi: 10.1111/anae.15453. Epub 2021 Mar 9.
It is unclear whether the association between vasopressor dose and mortality is affected by duration of administration. We examined whether prognostication in septic shock is feasible through the use of daily median vasopressor doses. We undertook a single-centre retrospective cohort study. We included patients with a diagnosis of septic shock admitted to the intensive care unit at Queen Elizabeth Hospital, Birmingham, UK, between April 2016 and July 2019. The primary outcome measure was 90-day mortality. We defined vasopressor dose as the median norepinephrine equivalent dose (equivalent infusion rates of all vasopressors and inotropes) recorded for each day, for the first four days of septic shock. We divided patients into groups by vasopressor dose quintiles and calculated their 90-day mortality rate. We examined area under the receiver operator characteristic curves for prognostic ability. In total, 844 patients were admitted with septic shock and had a 90-day mortality of 43% (n = 358). Over the first four days, median vasopressor dose decreased in 93% of survivors and increased in 56% of non-survivors. The mortality rate associated with a given vasopressor dose quintile increased on sequential days of septic shock. The area under the receiver operator characteristic curves of daily median vasopressor dose against mortality increased from day 1 to day 4 (0.67 vs. 0.86, p < 0.0001). By day 4, a median daily vasopressor dose > 0.05 μg.kg .min had an 80% sensitivity and specificity for mortality. The prognostic utility of vasopressor dose improved considerably with shock duration. Prolonged administration of small vasopressor doses was associated with a high attributable mortality.
目前尚不清楚血管加压药剂量与死亡率之间的关联是否受给药时间长短的影响。我们通过每日平均血管加压药剂量来检验脓毒性休克患者的预后是否可行。我们进行了一项单中心回顾性队列研究。我们纳入了 2016 年 4 月至 2019 年 7 月期间在英国伯明翰伊丽莎白女王医院重症监护病房诊断为脓毒性休克的患者。主要观察终点为 90 天死亡率。我们将血管加压药剂量定义为脓毒性休克前四天内每日记录的去甲肾上腺素等效剂量（所有血管加压药和正性肌力药的等效输注率）。我们根据血管加压药剂量五分位数将患者分为几组，并计算他们的 90 天死亡率。我们检查了接受者操作特征曲线下的面积以评估预后能力。总共有 844 名患者因脓毒性休克入院，90 天死亡率为 43%（n=358）。在最初的四天中，幸存者的平均血管加压药剂量中位数下降，而非幸存者的平均血管加压药剂量中位数增加。与特定血管加压药剂量五分位数相关的死亡率在脓毒性休克的连续天数中增加。每日平均血管加压药剂量与死亡率的接受者操作特征曲线下面积从第 1 天增加到第 4 天（0.67 比 0.86，p<0.0001）。到第 4 天，中位数每日血管加压药剂量>0.05μg.kg.min 时，死亡率的敏感性和特异性均为 80%。血管加压药剂量的预后实用性随着休克时间的延长而大大提高。小剂量血管加压药的长时间给药与高归因死亡率相关。
