Jacob C Jentzer1,2, Brandon Wiley1,2, Courtney Bennett1,2, Dennis H Murphree3, Mark T Keegan4, Kianoush B Kashani2,5, Malcolm R Bell1, Gregory W Barsness1. 1. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota. 2. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota. 3. Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota. 4. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota. 5. Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
Abstract
BACKGROUND: The use of norepinephrine may be associated with better outcomes in some patients with shock. We sought to determine whether norepinephrine was associated with lower mortality in unselected cardiac intensive care unit (CICU) patients compared with other vasopressors, and whether patterns of vasopressor and inotrope usage in the CICU have changed over time. METHODS: We retrospectively evaluated consecutive adult patients admitted to a tertiary care hospital CICU from January 1, 2007 to December 31, 2015. Vasoactive drug doses were quantified using the peak Vasoactive-Inotropic Score (VIS). Temporal trends were assessed using the Cochran-Armitage trends test and multivariable logistic regression was used to determine predictors of hospital mortality. RESULTS: We included 10,004 patients with a mean age of 67 ± 15 years; vasoactive drugs were used in 2,468 (24.7%) patients. Use of norepinephrine increased over time, whereas dopamine utilization decreased (P < 0.001 for trends). After adjustment for illness severity and other variables, the peak VIS was a predictor of hospital mortality across the entire population (unit odds ratio [OR] 1.013, 95% confidence interval [CI], 1.009-1.017, P < 0.001) and among patients receiving vasoactive drugs (OR 1.018, 95% CI, 1.013-1.022, P < 0.001). Among patients receiving vasoactive drugs, norepinephrine was associated with a lower risk of hospital mortality (OR 0.66, 95% CI, 0.49-0.90, P = 0.008) after adjustment for illness severity and peak VIS. CONCLUSIONS: Vasoactive drug use in CICU patients has a dose-dependent association with short-term mortality. Use of norepinephrine in CICU patients is associated with decreased odds of death when compared with other vasoactive drugs.
BACKGROUND: The use of norepinephrine may be associated with better outcomes in some patients with shock. We sought to determine whether norepinephrine was associated with lower mortality in unselected cardiac intensive care unit (CICU) patients compared with other vasopressors, and whether patterns of vasopressor and inotrope usage in the CICU have changed over time. METHODS: We retrospectively evaluated consecutive adult patients admitted to a tertiary care hospital CICU from January 1, 2007 to December 31, 2015. Vasoactive drug doses were quantified using the peak Vasoactive-Inotropic Score (VIS). Temporal trends were assessed using the Cochran-Armitage trends test and multivariable logistic regression was used to determine predictors of hospital mortality. RESULTS: We included 10,004 patients with a mean age of 67 ± 15 years; vasoactive drugs were used in 2,468 (24.7%) patients. Use of norepinephrine increased over time, whereas dopamine utilization decreased (P < 0.001 for trends). After adjustment for illness severity and other variables, the peak VIS was a predictor of hospital mortality across the entire population (unit odds ratio [OR] 1.013, 95% confidence interval [CI], 1.009-1.017, P < 0.001) and among patients receiving vasoactive drugs (OR 1.018, 95% CI, 1.013-1.022, P < 0.001). Among patients receiving vasoactive drugs, norepinephrine was associated with a lower risk of hospital mortality (OR 0.66, 95% CI, 0.49-0.90, P = 0.008) after adjustment for illness severity and peak VIS. CONCLUSIONS: Vasoactive drug use in CICU patients has a dose-dependent association with short-term mortality. Use of norepinephrine in CICU patients is associated with decreased odds of death when compared with other vasoactive drugs.
Authors: Ankeet S Bhatt; David D Berg; Erin A Bohula; Carlos L Alviar; Vivian M Baird-Zars; Christopher F Barnett; James A Burke; Anthony P Carnicelli; Sunit-Preet Chaudhry; Lori B Daniels; James C Fang; Christopher B Fordyce; Daniel A Gerber; Jianping Guo; Jacob C Jentzer; Jason N Katz; Norma Keller; Michael C Kontos; Patrick R Lawler; Venu Menon; Thomas S Metkus; Jose Nativi-Nicolau; Nicholas Phreaner; Robert O Roswell; Shashank S Sinha; R Jeffrey Snell; Michael A Solomon; Sean Van Diepen; David A Morrow Journal: J Card Fail Date: 2021-10 Impact factor: 6.592
Authors: Jacob C Jentzer; Brandon M Wiley; Yogesh N V Reddy; Christopher Barnett; Barry A Borlaug; Michael A Solomon Journal: Eur Heart J Acute Cardiovasc Care Date: 2022-03-16
Authors: Mitchell Padkins; Thomas Breen; Nandan Anavekar; Sean van Diepen; Timothy D Henry; David A Baran; Gregory W Barsness; Kianoush Kashani; David R Holmes; Jacob C Jentzer Journal: ESC Heart Fail Date: 2020-09-10
Authors: Jacob C Jentzer; Sean van Diepen; Steven M Hollenberg; Patrick R Lawler; Kianoush B Kashani Journal: Mayo Clin Proc Innov Qual Outcomes Date: 2021-12-23
Authors: Thomas J Breen; Courtney E Bennett; Sean Van Diepen; Jason Katz; Nandan S Anavekar; Joseph G Murphy; Malcolm R Bell; Gregory W Barsness; Jacob C Jentzer Journal: Mayo Clin Proc Innov Qual Outcomes Date: 2021-09-02
Authors: Kyung-Hee Kim; Jacob C Jentzer; Brandon M Wiley; William R Miranda; Courtney Bennett; Gregory W Barsness; Jae K Oh Journal: ESC Heart Fail Date: 2021-09-18
Authors: Nanna Louise Junker Udesen; Ole Kristian Lerche Helgestad; Jakob Josiassen; Christian Hassager; Henrik Frederiksen Højgaard; Louise Linde; Jesper Kjaergaard; Lene Holmvang; Lisette Okkels Jensen; Henrik Schmidt; Hanne Berg Ravn; Jacob Eifer Møller Journal: PLoS One Date: 2022-08-04 Impact factor: 3.752
Authors: Barry Burstein; Meir Tabi; Gregory W Barsness; Malcolm R Bell; Kianoush Kashani; Jacob C Jentzer Journal: Crit Care Date: 2020-08-20 Impact factor: 9.097