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Intensive Care Medicine

, 37:1432 | Cite as

Concomitant arginine-vasopressin and hydrocortisone therapy in severe septic shock: association with mortality

  • Christian Torgersen
  • Günter Luckner
  • Daniel C. H. Schröder
  • Christian A. Schmittinger
  • Christopher Rex
  • Hanno Ulmer
  • Martin W. Dünser
Original

Abstract

Purpose

To evaluate the association between concomitant arginine-vasopressin (AVP)/hydrocortisone therapy and mortality in severe septic shock patients.

Methods

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.

Results

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).

Conclusion

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.

Keywords

Arginine–vasopressin Hydrocortisone Septic shock Mortality 

Supplementary material

134_2011_2312_MOESM1_ESM.ppt (108 kb)
Supplementary material 1 (PPT 108 kb)

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Copyright information

© Copyright jointly held by Springer and ESICM 2011

Authors and Affiliations

  • Christian Torgersen
    • 1
  • Günter Luckner
    • 2
  • Daniel C. H. Schröder
    • 2
  • Christian A. Schmittinger
    • 1
  • Christopher Rex
    • 3
  • Hanno Ulmer
    • 4
  • Martin W. Dünser
    • 5
  1. 1.Department of Intensive Care MedicineInselspital, Bern Medical UniversityBernSwitzerland
  2. 2.Department of Anaesthesiology and Intensive Care MedicineInnsbruck Medical UniversityInnsbruckAustria
  3. 3.Department of Anaesthesiology and Intensive Care MedicineKreiskliniken ReutlingenReutlingenGermany
  4. 4.Department of Medical Statistics, Informatics and Health EconomicsInnsbruck Medical UniversityInnsbruckAustria
  5. 5.Department of Anaesthesiology and Intensive Care MedicineSalzburg General Hospital and Paracelsus Private Medical UniversitySalzburgAustria

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