pituitrin and Soft-Tissue-Infections

To identify predictors of hospital mortality among patients with severe sepsis who were treated with drotrecogin alfa (activated).. Prospective observational cohort study.. A 1400-bed academic medical center.. One hundred two patients treated with drotrecogin alfa (activated) for severe sepsis.. To identify potential risk factors for hospital mortality, the main outcome evaluated, all patients who received drotrecogin alfa (activated) were segregated according to hospital survival. The following characteristics were recorded: age, sex, weight, surgical or nonsurgical, Acute Physiology and Chronic Health Evaluation (APACHE) II score, number of acquired organ-system derangements, mechanical ventilation, use of vasopressors or dobutamine, patient location 24 hours before receiving drotrecogin alfa (activated), source of infection, microbiologically positive culture, and other process-of-care variables. Of the 102 patients, 43 (42.2%) died during their hospitalization. Potential predictors of hospital mortality identified by univariate analysis included greater APACHE II scores, administration of vasopressin or dobutamine, number of acquired organ-system derangements, time to treatment with drotrecogin alfa (activated), intravenous fluid administered before receiving vasopressors or drotrecogin alfa (activated), number of red blood cell transfusions, and administration of inappropriate initial antimicrobial treatment. Multivariate analysis revealed that vasopressin administration (odds ratio [OR] 3.72, 95% confidence interval [CI] 1.95-7.10), number of acquired organ-system derangements (OR 2.30, 95% CI 1.59-3.31), and administration of inappropriate initial antimicrobial treatment (OR 15.5, 95% CI 6.78-35.6) were independently associated with hospital mortality.. Number of acquired organ-system derangements, vasopressin administration, and treatment with an inappropriate initial antimicrobial regimen are independently associated with an increased risk of hospital mortality among patients treated with drotrecogin alfa (activated) for severe sepsis. These findings suggest that other specific medical interventions may increase survival in this patient population.

Topics: Gastrointestinal Diseases; Hospital Mortality; Humans; Inpatients; Intensive Care Units; Lung Diseases; Middle Aged; Prospective Studies; Protein C; Recombinant Proteins; Risk Factors; Sepsis; Severity of Illness Index; Skin Diseases, Bacterial; Soft Tissue Infections; Vasopressins

To assess the mechanisms underlying the inappropriately low plasma vasopressin levels reported in septic shock.. Prospective case series.. A 26-bed general medical intensive care unit at a university hospital.. Septic shock patients.. In three consecutive patients with septic shock, plasma vasopressin levels, circulating vasopressinase activity, baroreflex sensitivity, and neurohypophyseal vasopressin content were assessed. Plasma vasopressin concentration was unexpectedly within normal range in two patients (1.6 pg/mL and 1.8 pg/mL) and increased in one (16 pg/mL). In all cases, vasopressinase activity was undetectable, baroreflex sensitivity was decreased, and the high signal intensity of the posterior lobe of the pituitary gland on T1-weighted magnetic resonance images was absent. Magnetic resonance imaging and plasma vasopressin levels normalized after recovery from shock in the patient who survived.. These data suggest that in septic shock, inappropriately low plasma levels of vasopressin are at least partly related to a depletion of vasopressin stores in the neurohypophysis.

Topics: Aged; Baroreflex; Cystinyl Aminopeptidase; Fourier Analysis; Gas Gangrene; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Pituitary Gland, Posterior; Pneumonia; Prospective Studies; Shock, Septic; Soft Tissue Infections; Statistics, Nonparametric; Vasopressins