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

Critical Care

James A Russell²  Jeffrey Presneill⁵  Paul Hebert^1,12  Cheryl L Holmes¹  D James Cooper⁷  Michelle Storms²  Keith R Walley²  Terry CK Lee³  Joel Singer³  Dieter Ayers³  Chuin Siau^1,11  Anjuli Little^1,10  Kris Bandayrel^1,10  Gary Newton⁸  Stephen Lapinsky^1,10  Deborah J Cook⁹  Anthony C Gordon⁴  John Granton⁶  Sangeeta Mehta^1,10 

[1] Kelowna General Hospital, Kelowna, and University of British Columbia, Kelowna, British Columbia, Canada;Critical Care Research Laboratories, Heart and Lung Institute, St. Paul's Hospital, and University of British Columbia, Vancouver, British Columbia, Canada;School of Population and Public Health, Centre for Health Evaluation and Outcome Sciences, and University of British Columbia, Vancouver, British Columbia, Canada;Intensive Care, Charing Cross Hospital, Imperial College, London, UK;Mater Health Services, University of Queensland and Monash University, South Brisbane Queensland, Australia;University Health Network-General Division, University of Toronto, Toronto, Ontario, Canada;Alfred Hospital, Monash University, Melbourne, Australia;Department of Medicine and Division of Cardiology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada;Departments of Medicine, Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada;Department of Medicine and Interdepartmental Division of Critical Care Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada;Department of Respiratory Medicine, Changi General Hospital, Singapore;Ottawa Hospital-General Campus, and University of Ottawa, Ottawa, Ontario, Canada

关键词: electrocardiogram;    troponin;    norepinephrine;    vasopressin;    myocardial ischemia;    Septic shock;   

Others  :  818112
DOI  :  10.1186/cc12789

 received in 2012-12-20, accepted in 2013-06-20,  发布年份 2013

【 摘 要 】

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

【 授权许可】

   
2013 Mehta et al.; licensee BioMed Central Ltd.

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