The prognostic utility of vasopressor dose kinetics in septic shock

Chotalia, Minesh (2021). The prognostic utility of vasopressor dose kinetics in septic shock. University of Birmingham. M.Res.

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Abstract

It is unclear whether the association between vasopressor dose and mortality is affected by the duration of its administration. This thesis examines whether septic shock prognostication is feasible through the use of dynamically changing daily vasopressor dose. Patients diagnosed with septic shock and admitted to the Intensive Care Unit at Queen Elizabeth Hospital, Birmingham, UK, between April 2016 and July 2019 were included. Vasopressor dose was defined as the median noradrenaline equivalent dose (equivalent infusion rates of all vasopressors and inotropes) and recorded for each day, for the first four days of septic shock. Patients were divided into vasopressor dose quintiles and 90-day mortality rate was calculated. Area under the receiver operator characteristic curves (AUROC) examined prognostic ability. 844 patients were admitted with septic shock and the cohort had a 90-day mortality of 43%. Over the first four days, median vasopressor dose decreased in 93% of survivors and increased in 56% of non- survivors. In general, the mortality rate associated with a given vasopressor dose quintile increased on sequential days of septic shock. The AUROC of daily median vasopressor dose against mortality increased from day one to day four. By day four, a daily median vasopressor dose of 0.05μg/kg/minute 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 is a predictor of mortality from septic shock.

Type of Work:

Thesis (Masters by Research > M.Res.)

Award Type:

Masters by Research > M.Res.

Supervisor(s):