Eileen Friery, PharmD, BCCCP
The Wexner Medical Center at The Ohio State University, West Virginia, United States
Disclosure information not submitted.
Megan Conroy, MD
Pulmonogist
The Ohio State University Medical Center, United States
Disclosure information not submitted.
Kathryn Disney, PharmD
Pharmacy Specialist
University of Utah Huntsman Cancer Hospital, United States
Disclosure information not submitted.
Bruce Doepker, PharmD
Pharmacy Specialist
The Ohio State University Medical Center, United States
Disclosure information not submitted.
Alexandria Rydz, PharmD, BCCCP
Pharmacy Specialist
University of Missouri Health Care, United States
Disclosure information not submitted.
Jessica Elefritz, PharmD, BCCCP
PGY2 Critical Care Residency Program Director Critical Care Pharmacist
The Ohio State University Medical Center
Blacklick, Ohio
Disclosure information not submitted.
Title: Impact of Obesity on Mortality in Patients with Septic Shock Receiving Fixed-Dose Vasopressin
Introduction:
The Surviving Sepsis Guidelines recommend initiating fixed-dose vasopressin (AVP) for patients with persistent hypotension despite norepinephrine (NE), but it is unclear if this dosing strategy is sufficient in obese patients. The purpose of this study was to assess the impact of obesity on mortality in septic shock patients receiving fixed-dose AVP.
Methods:
An interim analysis of a multicenter, retrospective cohort study was conducted to assess the impact of fixed-dose AVP (0.03 or 0.04 units/min) on mortality in obese patients with septic shock compared to non-obese patients. Adults admitted to the medical intensive care unit with septic shock who received AVP for six hours were included. Patients were excluded if post-cardiac arrest or acute myocardial infarction, AVP initiated more than 48 hours after start of NE, AVP infusions that were titrated, or NE rate greater than 1.5 mcg/kg/min prior to AVP initiation. The primary outcome was in-hospital mortality compared between the obese and non-obese groups (BMI > 30 kg/m2 vs. < 30 kg/m2). Secondary outcomes included change in Sequential Organ Failure Assessment (SOFA) score from AVP initiation to 72 hours, vasopressor-free days, need for mechanical ventilation, and ICU and hospital length of stay.
Results:
747 patients admitted between September 2014-September 2020 were screened. Of the 416 patients included, 240 were in the non-obese group and 176 in the obese group. Baseline characteristics were similar between groups except for a higher baseline SOFA score in the obese group (14.0 vs. 12.0, p=0.001). The average APACHE II score was 29.3. There was a higher incidence of in-hospital mortality in the obese group compared to the non-obese group (70% vs. 57%, p=0.006). Similarly, the obese population had a smaller decrease in SOFA score at 72 hours compared to the non-obese population (1 vs. 3, p=0.028). Other secondary outcomes were similar between groups.
Conclusions:
Compared to non-obese patients, obese patients with septic shock receiving fixed-dose AVP had a higher incidence of mortality. This suggests that guideline recommended doses of AVP, which result in a lower weight-adjusted dose in obese patients, may be insufficient. Multivariable analysis will be performed to control for variables with the potential to confound the primary outcome.