Cargando…

In-hospital mortality following treatment with red blood cell transfusion or inotropic therapy during early goal-directed therapy for septic shock: a retrospective propensity-adjusted analysis

INTRODUCTION: We sought to investigate whether treatment of subnormal (<70%) central venous oxygen saturation (ScvO(2)) with inotropes or red blood cell (RBC) transfusion during early goal-directed therapy (EGDT) for septic shock is independently associated with in-hospital mortality. METHODS: Re...

Descripción completa

Detalles Bibliográficos
Autores principales: Mark, Dustin G, Morehouse, John W, Hung, Yun-Yi, Kene, Mamata V, Elms, Andrew R, Liu, Vincent, Ballard, Dustin W, Vinson, David R
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4181703/
https://www.ncbi.nlm.nih.gov/pubmed/25212411
http://dx.doi.org/10.1186/s13054-014-0496-y
_version_ 1782337405068509184
author Mark, Dustin G
Morehouse, John W
Hung, Yun-Yi
Kene, Mamata V
Elms, Andrew R
Liu, Vincent
Ballard, Dustin W
Vinson, David R
author_facet Mark, Dustin G
Morehouse, John W
Hung, Yun-Yi
Kene, Mamata V
Elms, Andrew R
Liu, Vincent
Ballard, Dustin W
Vinson, David R
author_sort Mark, Dustin G
collection PubMed
description INTRODUCTION: We sought to investigate whether treatment of subnormal (<70%) central venous oxygen saturation (ScvO(2)) with inotropes or red blood cell (RBC) transfusion during early goal-directed therapy (EGDT) for septic shock is independently associated with in-hospital mortality. METHODS: Retrospective analysis of a prospective EGDT patient database drawn from 21 emergency departments with a single standardized EGDT protocol. Patients were included if, during EGDT, they concomitantly achieved a central venous pressure (CVP) of ≥8 mm Hg and a mean arterial pressure (MAP) of ≥65 mm Hg while registering a ScvO(2) < 70%. Treatment propensity scores for either RBC transfusion or inotrope administration were separately determined from independent patient sub-cohorts. Propensity-adjusted logistic regression analyses were conducted to test for associations between treatments and in-hospital mortality. RESULTS: Of 2,595 EGDT patients, 572 (22.0%) met study inclusion criteria. The overall in-hospital mortality rate was 20.5%. Inotropes or RBC transfusions were administered for an ScvO(2) < 70% to 51.9% of patients. Patients were not statistically more likely to achieve an ScvO(2) of ≥70% if they were treated with RBC transfusion alone (29/59, 49.2%, P = 0.19), inotropic therapy alone (104/226, 46.0%, P = 0.15) or both RBC and inotropic therapy (7/12, 58.3%, P = 0.23) as compared to no therapy (108/275, 39.3%). Following adjustment for treatment propensity score, RBC transfusion was associated with a decreased adjusted odds ratio (aOR) of in-hospital mortality among patients with hemoglobin values less than 10 g/dL (aOR 0.42, 95% CI 0.18 to 0.97, P = 0.04) while inotropic therapy was not associated with in-hospital mortality among patients with hemoglobin values of 10 g/dL or greater (aOR 1.16, 95% CI 0.69 to 1.96, P = 0.57). CONCLUSIONS: Among patients with septic shock treated with EGDT in the setting of subnormal ScvO(2) values despite meeting CVP and MAP target goals, treatment with RBC transfusion may be independently associated with decreased in-hospital mortality.
format Online
Article
Text
id pubmed-4181703
institution National Center for Biotechnology Information
language English
publishDate 2014
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-41817032014-10-03 In-hospital mortality following treatment with red blood cell transfusion or inotropic therapy during early goal-directed therapy for septic shock: a retrospective propensity-adjusted analysis Mark, Dustin G Morehouse, John W Hung, Yun-Yi Kene, Mamata V Elms, Andrew R Liu, Vincent Ballard, Dustin W Vinson, David R Crit Care Research INTRODUCTION: We sought to investigate whether treatment of subnormal (<70%) central venous oxygen saturation (ScvO(2)) with inotropes or red blood cell (RBC) transfusion during early goal-directed therapy (EGDT) for septic shock is independently associated with in-hospital mortality. METHODS: Retrospective analysis of a prospective EGDT patient database drawn from 21 emergency departments with a single standardized EGDT protocol. Patients were included if, during EGDT, they concomitantly achieved a central venous pressure (CVP) of ≥8 mm Hg and a mean arterial pressure (MAP) of ≥65 mm Hg while registering a ScvO(2) < 70%. Treatment propensity scores for either RBC transfusion or inotrope administration were separately determined from independent patient sub-cohorts. Propensity-adjusted logistic regression analyses were conducted to test for associations between treatments and in-hospital mortality. RESULTS: Of 2,595 EGDT patients, 572 (22.0%) met study inclusion criteria. The overall in-hospital mortality rate was 20.5%. Inotropes or RBC transfusions were administered for an ScvO(2) < 70% to 51.9% of patients. Patients were not statistically more likely to achieve an ScvO(2) of ≥70% if they were treated with RBC transfusion alone (29/59, 49.2%, P = 0.19), inotropic therapy alone (104/226, 46.0%, P = 0.15) or both RBC and inotropic therapy (7/12, 58.3%, P = 0.23) as compared to no therapy (108/275, 39.3%). Following adjustment for treatment propensity score, RBC transfusion was associated with a decreased adjusted odds ratio (aOR) of in-hospital mortality among patients with hemoglobin values less than 10 g/dL (aOR 0.42, 95% CI 0.18 to 0.97, P = 0.04) while inotropic therapy was not associated with in-hospital mortality among patients with hemoglobin values of 10 g/dL or greater (aOR 1.16, 95% CI 0.69 to 1.96, P = 0.57). CONCLUSIONS: Among patients with septic shock treated with EGDT in the setting of subnormal ScvO(2) values despite meeting CVP and MAP target goals, treatment with RBC transfusion may be independently associated with decreased in-hospital mortality. BioMed Central 2014-09-12 2014 /pmc/articles/PMC4181703/ /pubmed/25212411 http://dx.doi.org/10.1186/s13054-014-0496-y Text en © Mark et al. licensee BioMed Central Ltd. 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Mark, Dustin G
Morehouse, John W
Hung, Yun-Yi
Kene, Mamata V
Elms, Andrew R
Liu, Vincent
Ballard, Dustin W
Vinson, David R
In-hospital mortality following treatment with red blood cell transfusion or inotropic therapy during early goal-directed therapy for septic shock: a retrospective propensity-adjusted analysis
title In-hospital mortality following treatment with red blood cell transfusion or inotropic therapy during early goal-directed therapy for septic shock: a retrospective propensity-adjusted analysis
title_full In-hospital mortality following treatment with red blood cell transfusion or inotropic therapy during early goal-directed therapy for septic shock: a retrospective propensity-adjusted analysis
title_fullStr In-hospital mortality following treatment with red blood cell transfusion or inotropic therapy during early goal-directed therapy for septic shock: a retrospective propensity-adjusted analysis
title_full_unstemmed In-hospital mortality following treatment with red blood cell transfusion or inotropic therapy during early goal-directed therapy for septic shock: a retrospective propensity-adjusted analysis
title_short In-hospital mortality following treatment with red blood cell transfusion or inotropic therapy during early goal-directed therapy for septic shock: a retrospective propensity-adjusted analysis
title_sort in-hospital mortality following treatment with red blood cell transfusion or inotropic therapy during early goal-directed therapy for septic shock: a retrospective propensity-adjusted analysis
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4181703/
https://www.ncbi.nlm.nih.gov/pubmed/25212411
http://dx.doi.org/10.1186/s13054-014-0496-y
work_keys_str_mv AT markdusting inhospitalmortalityfollowingtreatmentwithredbloodcelltransfusionorinotropictherapyduringearlygoaldirectedtherapyforsepticshockaretrospectivepropensityadjustedanalysis
AT morehousejohnw inhospitalmortalityfollowingtreatmentwithredbloodcelltransfusionorinotropictherapyduringearlygoaldirectedtherapyforsepticshockaretrospectivepropensityadjustedanalysis
AT hungyunyi inhospitalmortalityfollowingtreatmentwithredbloodcelltransfusionorinotropictherapyduringearlygoaldirectedtherapyforsepticshockaretrospectivepropensityadjustedanalysis
AT kenemamatav inhospitalmortalityfollowingtreatmentwithredbloodcelltransfusionorinotropictherapyduringearlygoaldirectedtherapyforsepticshockaretrospectivepropensityadjustedanalysis
AT elmsandrewr inhospitalmortalityfollowingtreatmentwithredbloodcelltransfusionorinotropictherapyduringearlygoaldirectedtherapyforsepticshockaretrospectivepropensityadjustedanalysis
AT liuvincent inhospitalmortalityfollowingtreatmentwithredbloodcelltransfusionorinotropictherapyduringearlygoaldirectedtherapyforsepticshockaretrospectivepropensityadjustedanalysis
AT ballarddustinw inhospitalmortalityfollowingtreatmentwithredbloodcelltransfusionorinotropictherapyduringearlygoaldirectedtherapyforsepticshockaretrospectivepropensityadjustedanalysis
AT vinsondavidr inhospitalmortalityfollowingtreatmentwithredbloodcelltransfusionorinotropictherapyduringearlygoaldirectedtherapyforsepticshockaretrospectivepropensityadjustedanalysis