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    Cardiac ischemia in patients with septic shock randomized to vasopressin or norepinephrine

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    Author
    Mehta, S; Granton, J; Gordon, AC; Cook, DJ; Lapinsky, S; Newton, G; Bandayrel, K; Little, A; Siau, C; Ayers, D; ...
    Date
    2013-01-01
    Source Title
    Critical Care (UK)
    Publisher
    BMC
    University of Melbourne Author/s
    Presneill, Jeffrey
    Affiliation
    Medicine and Radiology
    Metadata
    Show full item record
    Document Type
    Journal Article
    Citations
    Mehta, S., Granton, J., Gordon, A. C., Cook, D. J., Lapinsky, S., Newton, G., Bandayrel, K., Little, A., Siau, C., Ayers, D., Singer, J., Lee, T. C. K., Walley, K. R., Storms, M., Cooper, D. J., Holmes, C. L., Hebert, P., Presneill, J. & Russell, J. A. (2013). Cardiac ischemia in patients with septic shock randomized to vasopressin or norepinephrine. CRITICAL CARE, 17 (3), https://doi.org/10.1186/cc12789.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/256528
    DOI
    10.1186/cc12789
    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) versus norepinephrine (NE) on troponin, CK, and ECGs. METHODS: This was a prospective substudy of a randomized trial. Adults with septic shock randomly received, blinded, a low-dose infusion of VP (0.01 to 0.03 U/min) or NE (5 to 15 μg/min) in addition to open-label vasopressors, titrated to maintain a mean blood pressure of 65 to 75 mm Hg. Troponin I/T, CK, and CK-MB were measured, and 12-lead ECGs were recorded before 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 (interquartile range (IQR), 51.1 to 75.3), mean APACHE II 28.6 (SD 7.7)): 65 in the VP group and 56 in the NE group. At the four time points, 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 the NE groups. In multivariable analysis, only APACHE II was associated with 28-day mortality (OR, 1.07; 95% CI, 1.01 to 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.

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