Cardiac ischemia in patients with septic shock randomized to vasopressin or norepinephrine
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Introduction: Cardiac troponins are sensitive and specific biomarkers of myocardial necrosis. We evaluated troponin, CK, and ECG abnormalities in patients with septic shock; and compared the effect of vasopressin (VP) vs norepinephrine (NE) on troponin, CK, and ECGs.
Methods: This was a prospective substudy of a randomized trial. Adults with septic shock randomly received a blinded infusion of low-dose VP (0.01-0.03 U/min) or NE (5-15 μg/min) in addition to open-label vasopressors, titrated to maintain a mean blood pressure of 65-75 mmHg. Troponin I/T, CK, and CKMB were measured and 12-lead ECGs were recorded prior to study drug, and 6 hours, 2 days and 4 days after study drug initiation. Two physician readers, blinded to patient data and drug, independently interpreted ECGs.
Results: We enrolled 121 patients [median age 63.9 years (IQR 51.1,75.3), mean APACHE II 28.6 (SD 7.7)]: 65 in VP group and 56 in NE group. At the 4 timepoints, 26%, 36%, 32% and 21% of patients had troponin elevations, respectively. Baseline characteristics and outcomes were similar between patients with positive versus negative troponin levels. Troponin and CK levels, and rates of ischemic ECG changes were similar in the VP and NE groups. In multivariable analysis only APACHE II was associated with 28-day mortality (OR 1.07, 95% CI 1.01-1.14, p=0.033).
Conclusions: Troponin elevation is common in adults with septic shock. We observed no significant differences in troponin, CK, and ECGs in patients treated with vasopressin and norepinephrine. Troponin elevation was not an independent predictor of mortality.
Trial registration: Controlled-trials.com ISRCTN94845869.
Methods: This was a prospective substudy of a randomized trial. Adults with septic shock randomly received a blinded infusion of low-dose VP (0.01-0.03 U/min) or NE (5-15 μg/min) in addition to open-label vasopressors, titrated to maintain a mean blood pressure of 65-75 mmHg. Troponin I/T, CK, and CKMB were measured and 12-lead ECGs were recorded prior to study drug, and 6 hours, 2 days and 4 days after study drug initiation. Two physician readers, blinded to patient data and drug, independently interpreted ECGs.
Results: We enrolled 121 patients [median age 63.9 years (IQR 51.1,75.3), mean APACHE II 28.6 (SD 7.7)]: 65 in VP group and 56 in NE group. At the 4 timepoints, 26%, 36%, 32% and 21% of patients had troponin elevations, respectively. Baseline characteristics and outcomes were similar between patients with positive versus negative troponin levels. Troponin and CK levels, and rates of ischemic ECG changes were similar in the VP and NE groups. In multivariable analysis only APACHE II was associated with 28-day mortality (OR 1.07, 95% CI 1.01-1.14, p=0.033).
Conclusions: Troponin elevation is common in adults with septic shock. We observed no significant differences in troponin, CK, and ECGs in patients treated with vasopressin and norepinephrine. Troponin elevation was not an independent predictor of mortality.
Trial registration: Controlled-trials.com ISRCTN94845869.
Date Issued
2013
Citation
Critical Care, 2013, 17, pp.R117-
ISSN
1364-8535
Publisher
BioMed Central
Start Page
R117
End Page
R117
Journal / Book Title
Critical Care
Volume
17
Copyright Statement
© 2013 Mehta et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
License URL
Description
23/07/13 KB. OK to add accepted version to Spiral (published pdf not yet available). Biomed Cemtral
Identifier
http://ccforum.com/content/17/3/R117
3
Publisher URL
Article Number
3