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Characteristics of Patients with Vasodilatory Shock in Medical Information Mart for Intensive Care (MIMIC-III) - A Retrospective Study
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A3266 - Characteristics of Patients with Vasodilatory Shock in Medical Information Mart for Intensive Care (MIMIC-III) - A Retrospective Study
Author Block: F. Zeng1, M. E. Gerbasi2, G. Oster2, A. Grossman2, S. Chen1, L. S. Chawla1; 1La Jolla Pharmaceutical Company, San Diego, CA, United States, 2Policy Analysis Inc., Brookline, MA, United States.
Rationale Vasodilatory shock is characterized by hypotension despite preserved cardiac output. Patients requiring high-dose vasopressors have worse outcomes. However, the incidence of patients with severe vasodilatory shock is not well characterized. Methods This retrospective study is using the Medical Information Mart for Intensive Care (MIMIC-III) database from Beth Israel Deaconess Medical Center (BIDMC) in Boston, Massachusetts, to examine treatment and outcomes in patients with vasodilatory shock. MIMIC-III contains detailed information for 61,532 admissions to intensive care units (ICU) at BIDMC between 2001 and 2012. A cohort of adult patients (age ≥18 years) who primarily suffered from vasodilatory shock was identified by including patients receiving continuous vasopressors for ≥6 hours, provided they had no evidence of cardiac surgery, vasoplegia, cardiogenic shock, intra-aortic balloon pump, extracorporeal membrane oxygenation, large amount of blood transfusion, cardiac tamponade or pulmonary embolism. Patients with inadequate response to vasopressors were identified based on norepinephrine-equivalent dose greater than or equal to 0.2 μg/kg/min for at least 6 continuous hours. Results Between 2001 and 2012, there were a total of 5,922 ICU admissions of patients with vasodilatory shock at BIDMC. Mean age was 66 years and 46% of patients were women. Mean time from ICU admission to initial receipt of vasopressors was 23 hours. Approximately 40% of patients had evidence of inadequate response to vasopressors, and overall ICU mortality was 30% (95% confidence interval [CI]=29%, 31%). Mortality was substantially higher among those with inadequate response to vasopressors (48% [95% CI=46%, 50%] vs 18% [95% CI=17%, 19%] for all other patients). Conclusions Almost 10% of all admissions to BIDMC ICUs between 2001 and 2012 involved patients with vasodilatory shock. ICU mortality was substantially higher among those with evidence of inadequate response to vasopressors.
Author Block: F. Zeng1, M. E. Gerbasi2, G. Oster2, A. Grossman2, S. Chen1, L. S. Chawla1; 1La Jolla Pharmaceutical Company, San Diego, CA, United States, 2Policy Analysis Inc., Brookline, MA, United States.
Rationale Vasodilatory shock is characterized by hypotension despite preserved cardiac output. Patients requiring high-dose vasopressors have worse outcomes. However, the incidence of patients with severe vasodilatory shock is not well characterized. Methods This retrospective study is using the Medical Information Mart for Intensive Care (MIMIC-III) database from Beth Israel Deaconess Medical Center (BIDMC) in Boston, Massachusetts, to examine treatment and outcomes in patients with vasodilatory shock. MIMIC-III contains detailed information for 61,532 admissions to intensive care units (ICU) at BIDMC between 2001 and 2012. A cohort of adult patients (age ≥18 years) who primarily suffered from vasodilatory shock was identified by including patients receiving continuous vasopressors for ≥6 hours, provided they had no evidence of cardiac surgery, vasoplegia, cardiogenic shock, intra-aortic balloon pump, extracorporeal membrane oxygenation, large amount of blood transfusion, cardiac tamponade or pulmonary embolism. Patients with inadequate response to vasopressors were identified based on norepinephrine-equivalent dose greater than or equal to 0.2 μg/kg/min for at least 6 continuous hours. Results Between 2001 and 2012, there were a total of 5,922 ICU admissions of patients with vasodilatory shock at BIDMC. Mean age was 66 years and 46% of patients were women. Mean time from ICU admission to initial receipt of vasopressors was 23 hours. Approximately 40% of patients had evidence of inadequate response to vasopressors, and overall ICU mortality was 30% (95% confidence interval [CI]=29%, 31%). Mortality was substantially higher among those with inadequate response to vasopressors (48% [95% CI=46%, 50%] vs 18% [95% CI=17%, 19%] for all other patients). Conclusions Almost 10% of all admissions to BIDMC ICUs between 2001 and 2012 involved patients with vasodilatory shock. ICU mortality was substantially higher among those with evidence of inadequate response to vasopressors.
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