Vasopressin use in critically ill cirrhosis patients with catecholamine-resistant septic shock: The CVICU cohort

Table 1 Baseline patient characteristics

	Vasopressin (n = 21)	No Vasopressin (n =24)	P value
Patient demographics
Age, yr (95%CI)	56.2 (50.2-62.3)	57.0 (50.7-63.3)	0.681
Male gender	10 (47.6)	14 (53.9)	0.672
Body mass index, kg/m2, (95%CI)	34.2 (30.5-37.9)	31.2 (28.0-34.3)	0.150
Comorbidities, n (%)
CAD	3 (14.2)	4 (16.7)	0.985
CHF	1 (5.3)	6 (23.1)	0.103
COPD	3 (16.7)	4 (16.7)	1.00
CKD	6 (28.6)	7 (29.2)	0.956
DM	7 (35.0)	8 (30.8)	0.762
HTN	13 (61.3)	16 (66.7)	0.916
Smoking, n (%)	5 (23.8)	5 (23.8)	0.756
Alcohol use (active), n (%)	9 (42.9)	8 (33.3)	0.392
Liver disease etiology, n (%)
Alcohol	6 (28.6)	10 (41.7)	0.477
NASH/crypto	5 (23.4)	7 (29.2)	0.240
HBV	0 (0.0)	0 (0.0)	1.00
HCV	3 (14.2)	3 (12.5)	0.566
Cardiac	1 (4.8)	1 (4.2)	0.947
Cholestatic	2 (9.5)	1 (4.2)	0.445
AIH	0 (0.0)	1 (4.2)	0.497
HCV/alcohol	3 (14.3)	1 (4.2)	0.329
PSE	14 (66.7)	15 (62.5)	0.927
Laboratory values and vital signs
MELD, (95%CI)	32.4 (28.6-36.2)	27.1 (23.6-30.6)	0.041
CTP, n (%)
A	0 (0.0)	0 (0.0)	1.00
B	2 (9.5)	6 (25.0)	0.074
C	19 (90.5)	18 (75.0)	0.162
AST, U/L, (95%CI)	429 (283-1141)	289 (90-667)	0.763
ALT, U/L, (95%CI)	180 (79-438)	133 (24-290)	0.795
Alk phos, U/L, (95%CI)	155 (109-200)	138 (90-185)	0.740
Bilirubin, mg/dL, (95%CI)	15.4 (9.0-21.9)	10.0 (5.3-14.6)	0.109
BUN, mg/dL, (95%CI)	58.0 (45.0-70.9)	48.7 (36.5-60.9)	0.222
Platelets, k/uL, (95%CI)	84.5 (66.2-102.8)	88.8 (68.9-108.8)	0.402
Creatinine, mg/dL, (95%CI)	3.02 (2.16-3.88)	2.50 (1.59-3.41)	0.37
GFR, mL/min per 1.73 m2, (95%CI)	23.9 (18.6-29.2)	40.0 (29.1-51.0)	0.013
Sodium, mmol/L, (95%CI)	135.8 (131.8-139.8)	134.1 (130.8-137.5)	0.553
INR, (95%CI)	2.63 (1.79-3.48)	2.15 (1.82-2.47)	0.176
Hematocrit, %, (95%CI)	25.7 (22.9-28.6)	28.0 (26.1-30.0)	0.200
Lactate, mmol/L, (95%CI)	3.90 (2.58-5.21)	3.60 (2.52-4.68)	0.669
WBC (max), k/uL, (95%CI)	16.1 (12.8-19.5)	16.7 (12.7-20.6)	0.607
Heart rate, (95%CI)	106 (96-115)	110 (102-118)	0.591
MAP (min), (95%CI)	45.1 (34.2-56.1)	50.5 (46.9-54.0)	0.197
Temperature, C, (95%CI)	36.3 (35.5-37.1)	36.7 (35.9-37.4)	0.125
RR (max), breaths/min, (95%CI)	35.7 (30.5-40.8)	31.8 (25.4-38.3)	0.145
ICU level of illness, (95%CI)
FiO2	0.48 (0.36-0.59)	0.44 (0.34-0.54)	0.953
PaCO2	35.6 (32.7-38.5)	35.7 (32.1-39.3)	0.856
PaO2	100.2 (49.1-151.4)	70.4 (60.2-80.6)	0.235
pH	7.30 (7.24-7.35)	7.34 (7.30-7.37)	0.149
APACHE II	33.5 (30.6-36.5)	31.8 (29.4-34.2)	0.306
GCS	7.1 (5.0-9.3)	6.9 (5.2-8.6)	0.547
SAPSII	72.6 (63.5-81.7)	70.3 (64.5-76.1)	0.975
SOFA	17.6 (15.9-19.3)	16.9 (15.9-18.0)	0.173
Average number of vasopressors	2.9 (2.4-3.3)	3.3 (2.9-3.6)	0.357
Days on vasopressors	6.3 (3.7-8.9)	6.3 (3.6-9.0)	0.756
CRRT/HD, n (%)	13 (65.0)	17 (70.8)	0.762
Intubated, n (%)	18 (85.7)	22 (91.7)	0.466
UOP first 24 h, mL, (95%CI)	459.9 (225.8-694.0)	698.1 (383.9-1012.3)	0.067
GI bleed, n (%)	1 (20.0)	5 (20.8)	0.948
New VTE, n (%)	4 (20.0)	3 (12.5)	0.635
ICU medications
Volume of IVF (L), (95%CI)	4.02 (2.52-5.53)	4.44 (2.62-6.26)	0.891
Octreotide, n (%)	14 (66.7)	12 (52.2)	0.329
Antibiotics, n (%)	21 (100.0)	24 (100.0)	0.790
Choice of first vasopressor, n (%)
Norepinephrine	18 (85.7)	17 (70.8)	0.412
Dopamine	1 (4.8)	3 (12.5)	0.398
Phenylephrine	2 (9.5)	4 (16.7)	0.207
Albumin given, n (%)	18 (85.7)	21 (95.5)	0.954
PPI, n (%)	18 (90.0)	19 (79.2)	0.388
Corticosteroids, n (%)	16 (76.2)	19 (79.2)	0.701
Outcomes, (95%CI)
Days to death	8.9 (5.2-11.4)	7.8 (4.4-11.1)	0.672
ICU LOS, d	13.5 (8.1-18.8)	12.3 (4.4-20.3)	0.114
Vent free days	22.6 (20.1-25.1)	15.8 (4.1-27.6)	0.633
Mortality, n (%)
7 d	11 (52.4)	14 (58.3)	0.408
28 d	17 (81.0)	21 (87.5)	0.371
90 d	18 (85.7)	21 (87.5)	0.303
In hospital	18 (85.7)	20 (83.3)	0.654
ICU	17 (81.0)	18 (75.0)	0.360
Transition to comfort care	16 (76.2)	18 (75.0)	0.808

CAD: Coronary heart disease; CHF: Congestive heart failure; COPD: Chronic obstructive pulmonary diseases; CKD: Chronic kidney diseases; DM: Diabetes mellitus; HTN: Hypertension; NASH: Non-alcoholic steatohepatitis; HBV: Hepatitis B virus; HCV: Hepatitis C virus; AIH: Autoimmune hepatitis; PSE: Portosystemic encephalopathy; CTP: Child-Turcotte-Pugh score; AST: Aspartate aminotransferase; ALT: Alanine transaminase; BUN: Blood urea nitrogen; WBC: White blood cell; ICU: Intensive care unit; APACHE II: Acute physiology and chronic health evaluation II; SAPSII: Simplified acute physiology score; SOFA: Sequential organ failure assessment; CRRT: Continuous renal replacement therapy; HD: Hemodialysis; GI: Gastrointestinal; PPI: Proton pump inhibitors.

Table 2 Change in laboratory parameters with vasopressor support as measured 24 h after vasopressor initiation

	Vasopressin (n = 21)	No Vasopressin (n = 24)	P value
Platelets, k/uL, (95%CI)	-18.7 (-42.3, 4.9)	-13.6 (-31.6, 4.4)	NS
ALT, U/L, (95%CI)	47.2 (-12.1, 106.6)	206.3 (-113.3, 525.9)	NS
AST, U/L (95%CI)	236.7 (74.0, 399.4)	292.4 (-247.0, 831.8)	NS
Alkaline phosphatase, U/L, (95%CI)	-10.5 (-48.7, 27.8)	-19.6 (-39.5, 0.3)	NS
Heart rate, (95%CI)	-6.7 (-12.3, -1.0)	0.6 (-11.8, 13.0)	NS
Bilirubin, mg/dL, (95%CI)	0.45 (-0.99, 1.89)	0.87 (-0.64, 2.38)	NS

AST: Aspartate aminotransferase; ALT: Alanine transaminase; NS: No statistical significance.

Table 3 Adjusted multivariable analysis for predictors of 28-d all-cause mortality

	Hazard ratio	95%CI	P value
Vasopressin1	0.77	0.39-1.52	NS
Age (yr)	1.05	1.01-1.08	0.004
CRRT	0.40	0.19-0.85	0.017
Corticosteroids	0.37	0.16-0.86	0.021
Sodium (mmol/L)	1.00	0.96-1.04	NS
Platelets (k/uL)	0.99	0.98-1.00	NS
MELD	1.04	0.98-1.09	NS

¹Compared to reference of non-vasopressin group (P = 0.553). CRRT: Continuous renal replacement therapy; NS: No statistical significance.