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Septic Shock Requiring Three Vasopressors: Patient Demographics and Outcomes
Gloria H Kwak1,2,3, Rajapaksha W M A Madushani4, Lasith Adhikari4
1Harvard Medical School, Boston, MA.
Critical Care Explorations
|November 8, 2024
Summary
Septic shock requiring three or more vasopressors has a high mortality rate. Identifying high-risk patients with elevated lactate, creatinine, and older age is crucial for management.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Epidemiology
Background:
- Septic shock is a life-threatening condition requiring intensive hemodynamic support.
- Vasopressors are critical for managing septic shock, but data on patients needing multiple agents is limited.
Purpose of the Study:
- To characterize demographics and identify prognostic factors for mortality in septic shock patients requiring three or more vasopressors.
Main Methods:
- Multicenter retrospective cohort study using MIMIC-IV and eICU databases.
- Included over 400,000 ICU admissions, focusing on 3447 patients meeting Sepsis-3 criteria and receiving ≥3 vasopressors for ≥2 hours.
Main Results:
- In-hospital mortality was 57.6% for patients requiring three or more vasopressors.
- Independent mortality predictors included elevated ICU lactate, longer time to third vasopressor, increased creatinine, and age >60.
- Race and agitation scores were not associated with mortality.
Conclusions:
- Septic shock requiring extensive vasopressor support portends a very high mortality risk.
- Understanding these risk factors can guide clinical management and shared decision-making with patients and families.
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