Association between vasopressin administration and mortality in patients with cardiogenic shock.

IF 3.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal Pub Date : 2025-03-20 DOI:10.1016/j.ahj.2025.03.009

Dhruv Sarma, Ryan Smith, Mitchell Padkins, Aniket S Rali, Saraschandra Vallabhajosyula, Ashish K Khanna, Kianoush Kashani, Benjamin Hibbert, Jacob C Jentzer

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引用次数: 0

Abstract

Background: The utility of vasopressin as an adjunctive, catecholamine-sparing vasopressor in cardiogenic shock (CS) has not been widely examined.

Methods: We included consecutive adult patients admitted with a diagnosis of CS requiring vasopressors. High-dose vasopressors (HDV) were defined as ≥0.3 mcg/kg/min of norepinephrine equivalent. Multivariable logistic regression and propensity analysis was used to calculate odds ratio (OR) and 95% confidence interval (CI) values for in-hospital mortality, before and after adjustment for relevant covariates.

Results: We included 721 CS patients, including HDV in 32.5%. Vasopressin was administered in 207 (29%) patients within the first 24 hours. In-hospital mortality occurred in 38.1% and was higher in the HDV group (56.8% vs. 29.2%). Vasopressin was associated with lower propensity adjusted in-hospital mortality (adjusted OR 0.59, 95% CI 0.35-0.99, p = 0.05). Vasopressin use was also associated with lower mortality in the HDV group (unadjusted OR 0.54, 95% CI 0.32-0.92, p = 0.02).

Conclusions: Vasopressin use in the first 24 hours was associated with lower adjusted mortality in patients with CS, particularly amongst those requiring HDV. The use of vasopressin in CS merits dedicated prospective evaluation.

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心源性休克患者服用血管加压素与死亡率之间的关系。

背景：在心源性休克（CS）中，血管加压素作为儿茶酚胺抑制剂的辅助作用尚未得到广泛研究：我们连续收治了诊断为 CS 并需要使用血管加压素的成年患者。高剂量血管加压药（HDV）的定义是去甲肾上腺素当量≥0.3 mcg/kg/min。在调整相关协变量之前和之后，采用多变量逻辑回归和倾向分析计算院内死亡率的几率比（OR）和 95% 置信区间（CI）值：我们纳入了 721 名 CS 患者，其中 32.5% 为 HDV 患者。207名患者（29%）在最初24小时内使用了血管加压素。院内死亡率为 38.1%，HDV 组死亡率更高（56.8% 对 29.2%）。血管加压素与较低的倾向调整后院内死亡率相关（调整后 OR 0.59，95% CI 0.35-0.99，p = 0.05）。使用血管加压素也与HDV组较低的死亡率有关（未调整OR为0.54，95% CI为0.32-0.92，p = 0.02）：结论：在最初的24小时内使用血管加压素与降低CS患者的调整后死亡率有关，尤其是在需要使用HDV的患者中。在 CS 中使用血管加压素值得进行专门的前瞻性评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American heart journal 医学-心血管系统

CiteScore

8.20

自引率

2.10%

发文量

214

审稿时长

38 days

期刊介绍： The American Heart Journal will consider for publication suitable articles on topics pertaining to the broad discipline of cardiovascular disease. Our goal is to provide the reader primary investigation, scholarly review, and opinion concerning the practice of cardiovascular medicine. We especially encourage submission of 3 types of reports that are not frequently seen in cardiovascular journals: negative clinical studies, reports on study designs, and studies involving the organization of medical care. The Journal does not accept individual case reports or original articles involving bench laboratory or animal research.