van Loon, S.W. (2024) Predictive value of individual factors on vasopressor therapy for sepsis patients in the emergency department. thesis, Medicine.
Full text available on request.Abstract
Introduction: Current hemodynamic sepsis treatment involves fluid resuscitation and vasopressor therapy. In some patients, a one-size-fits-all approach may result in fluid overload or prolonged shock. Identifying individual factors influencing vasopressor need is essential in developing a personalized hemodynamic resuscitation strategy. This study aims to determine the predictive value of individual factors on the need for vasopressor therapy within 24 hours after ED admission. Methods: This study is a post-hoc analysis of prospectively collected data from the Acutelines data- and biobank. Patients meeting criteria for a high-likely or confirmed infection and hemodynamic instability were included from the databank. Patients were categorized based on the endpoint criteria: vasopressor use in the first 24 hours after ED admission. Alongside descriptive statistics, univariate and multivariate logistic regression analyses were conducted. The multivariate model's predictive performance was assessed against the NEWS and qSOFA scores using AUROC. Results: Both the non-vasopressor and vasopressor group consisted of 100 patients. In the multivariate logistic regression analysis, alcohol use (OR, 2.478; 95% CI, 1.120-5.705; p=0.028), systolic blood pressure (OR, 0.971; 95% CI, 0.955-0.985; p<0.001), heart rate (OR, 1.0.21; 95% CI, 1.004-1.039; p=0.019), peripheral SpO2 (OR, 0.864; 95% CI, 0.780-0.940; p=0.002), GCS <14 (OR, 5.354; 95% CI, 1.809-18.313; p=0.004), abdominal infection source (OR, 3.281; 95% CI, 1.050-10.869; p=0.045), three or more infection sources (OR, 5.085; 95% CI, 1.249-25.480; p=0.030), prehospital fluid administration of 500-999 mL (OR, 3.327; 95% CI, 1.566-7.291; p=0.002) and prehospital fluid administration of 1000-1499 mL (OR, 4.651; 95% CI, 1.173-21.058; p=0.034) was associated with vasopressor use. The multivariate model (AUC, 0.830; 95% CI 0.790-0.840) showed superior predictive performance compared to the qSOFA (AUC, 0.710; 95% CI, 0.640-0.710) (p<0.001), but not to the NEWS model (AUC, 0.800; 95% CI, 0.740-0.800). Conclusion: Alcohol use, systolic blood pressure, heart rate, peripheral SpO2, abdominal infection source, three or more infection sources, and prehospital fluid administration are associated with requiring vasopressor therapy within the first 24 hours after ED admission. This is a crucial step in developing personalized hemodynamic resuscitation in sepsis management, but further investigation is needed. Keywords: sepsis; septic shock; emergency department; personalized treatment; hemodynamic resuscitation; fluid resuscitation; vasopressor therapy; individual factors; predictive performance; NEWS; qSOFA.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Ter Horst, MSc, S. and Prof. Dr. Bouma, H.R. |
| Faculty: | Medical Sciences |
| Date Deposited: | 23 Oct 2024 11:37 |
| Last Modified: | 23 Oct 2024 11:37 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3774 |
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