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Open Access 01-06-2013 | Research

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

Authors: Sangeeta Mehta, John Granton, Anthony C Gordon, Deborah J Cook, Stephen Lapinsky, Gary Newton, Kris Bandayrel, Anjuli Little, Chuin Siau, Dieter Ayers, Joel Singer, Terry CK Lee, Keith R Walley, Michelle Storms, D James Cooper, Cheryl L Holmes, Paul Hebert, Jeffrey Presneill, James A Russell, for the Vasopressin and Septic Shock Trial (VASST) Investigators

Published in: Critical Care | Issue 3/2013

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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Title: Cardiac ischemia in patients with septic shock randomized to vasopressin or norepinephrine
Authors: Sangeeta Mehta
John Granton
Anthony C Gordon
Deborah J Cook
Stephen Lapinsky
Gary Newton
Kris Bandayrel
Anjuli Little
Chuin Siau
Dieter Ayers
Joel Singer
Terry CK Lee
Keith R Walley
Michelle Storms
D James Cooper
Cheryl L Holmes
Paul Hebert
Jeffrey Presneill
James A Russell
for the Vasopressin and Septic Shock Trial (VASST) Investigators
Publication date: 01-06-2013
Publisher: BioMed Central
Published in: Critical Care / Issue 3/2013
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc12789

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

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

Abstract

Introduction

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Trial registration

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