The order of vasopressor discontinuation and incidence of hypotension: a retrospective cohort analysis

Abstract The optimal order of vasopressor discontinuation during shock resolution remains unclear. We evaluated the incidence of hypotension in patients receiving concomitant vasopressin (VP) and norepinephrine (NE) based on the order of their discontinuation. In this retrospective cohort study, con...

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Autores principales:	Xuan Song, Xinyan Liu, Kimberly D. Evans, Ryan D. Frank, Erin F. Barreto, Yue Dong, Chang Liu, Xiaolan Gao, Chunting Wang, Kianoush B. Kashani
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/069489ba560d466e95d4786eec22f1de
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spelling	oai:doaj.org-article:069489ba560d466e95d4786eec22f1de2021-12-02T16:46:34ZThe order of vasopressor discontinuation and incidence of hypotension: a retrospective cohort analysis10.1038/s41598-021-96322-72045-2322https://doaj.org/article/069489ba560d466e95d4786eec22f1de2021-08-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-96322-7https://doaj.org/toc/2045-2322Abstract The optimal order of vasopressor discontinuation during shock resolution remains unclear. We evaluated the incidence of hypotension in patients receiving concomitant vasopressin (VP) and norepinephrine (NE) based on the order of their discontinuation. In this retrospective cohort study, consecutive patients receiving concomitant VP and NE infusions for shock admitted to intensive care units were evaluated. The primary outcome was hypotension incidence following discontinuation of VP or NE (VP1 and NE1 groups, respectively). Secondary outcomes included the incidence of acute kidney injury (AKI) and arrhythmias. Subgroup analysis was conducted by examining outcomes based on the type of shock. Of the 2,035 included patients, 952 (46.8%) were VP1 and 1,083 (53.2%) were NE1. VP1 had a higher incidence of hypotension than NE1 (42.1% vs. 14.2%; P < 0.001), longer time to shock reversal (median: 2.5 vs. 2.2 days; P = .009), higher hospital [29% (278/952) vs. 24% (258/1083); P = .006], and 28-day mortality [37% (348/952) vs. 29% (317/1,083); P < 0.001] when compared with the NE1 group. There were no differences in ICU mortality, ICU and hospital length of stay, new-onset arrhythmia, or AKI incidence between the two groups. In subgroup analyses based on different types of shock, similar outcomes were observed. After adjustments, hypotension in the following 24 h and 28-day mortality were significantly higher in VP1 (Odds ratios (OR) 4.08(3.28, 5.07); p-value < .001 and 1.27(1.04, 1.55); p-value < .001, respectively). Besides, in a multivariable model, the need for renal replacement therapy (OR 1.68 (1.34, 2.12); p-value < .001) was significantly higher in VP1. Among patients with shock who received concomitant VP and NE, the VP1 group was associated with a higher incidence of hypotension in comparison with NE1. Future studies need to validate our findings and their impact on clinical outcomes.Xuan SongXinyan LiuKimberly D. EvansRyan D. FrankErin F. BarretoYue DongChang LiuXiaolan GaoChunting WangKianoush B. KashaniNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Xuan Song Xinyan Liu Kimberly D. Evans Ryan D. Frank Erin F. Barreto Yue Dong Chang Liu Xiaolan Gao Chunting Wang Kianoush B. Kashani The order of vasopressor discontinuation and incidence of hypotension: a retrospective cohort analysis
description	Abstract The optimal order of vasopressor discontinuation during shock resolution remains unclear. We evaluated the incidence of hypotension in patients receiving concomitant vasopressin (VP) and norepinephrine (NE) based on the order of their discontinuation. In this retrospective cohort study, consecutive patients receiving concomitant VP and NE infusions for shock admitted to intensive care units were evaluated. The primary outcome was hypotension incidence following discontinuation of VP or NE (VP1 and NE1 groups, respectively). Secondary outcomes included the incidence of acute kidney injury (AKI) and arrhythmias. Subgroup analysis was conducted by examining outcomes based on the type of shock. Of the 2,035 included patients, 952 (46.8%) were VP1 and 1,083 (53.2%) were NE1. VP1 had a higher incidence of hypotension than NE1 (42.1% vs. 14.2%; P < 0.001), longer time to shock reversal (median: 2.5 vs. 2.2 days; P = .009), higher hospital [29% (278/952) vs. 24% (258/1083); P = .006], and 28-day mortality [37% (348/952) vs. 29% (317/1,083); P < 0.001] when compared with the NE1 group. There were no differences in ICU mortality, ICU and hospital length of stay, new-onset arrhythmia, or AKI incidence between the two groups. In subgroup analyses based on different types of shock, similar outcomes were observed. After adjustments, hypotension in the following 24 h and 28-day mortality were significantly higher in VP1 (Odds ratios (OR) 4.08(3.28, 5.07); p-value < .001 and 1.27(1.04, 1.55); p-value < .001, respectively). Besides, in a multivariable model, the need for renal replacement therapy (OR 1.68 (1.34, 2.12); p-value < .001) was significantly higher in VP1. Among patients with shock who received concomitant VP and NE, the VP1 group was associated with a higher incidence of hypotension in comparison with NE1. Future studies need to validate our findings and their impact on clinical outcomes.
format	article
author	Xuan Song Xinyan Liu Kimberly D. Evans Ryan D. Frank Erin F. Barreto Yue Dong Chang Liu Xiaolan Gao Chunting Wang Kianoush B. Kashani
author_facet	Xuan Song Xinyan Liu Kimberly D. Evans Ryan D. Frank Erin F. Barreto Yue Dong Chang Liu Xiaolan Gao Chunting Wang Kianoush B. Kashani
author_sort	Xuan Song
title	The order of vasopressor discontinuation and incidence of hypotension: a retrospective cohort analysis
title_short	The order of vasopressor discontinuation and incidence of hypotension: a retrospective cohort analysis
title_full	The order of vasopressor discontinuation and incidence of hypotension: a retrospective cohort analysis
title_fullStr	The order of vasopressor discontinuation and incidence of hypotension: a retrospective cohort analysis
title_full_unstemmed	The order of vasopressor discontinuation and incidence of hypotension: a retrospective cohort analysis
title_sort	order of vasopressor discontinuation and incidence of hypotension: a retrospective cohort analysis
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/069489ba560d466e95d4786eec22f1de
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The order of vasopressor discontinuation and incidence of hypotension: a retrospective cohort analysis

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