LAUSR

Introduction/Hypothesis: Septic shock results in high rates of morbidity and mortality. There are no consensus guideline recommendations with regards to the starting dose. It is recommended to titrate vasopressors to a mean arterial pressure (MAP) goal and failure to do so in the first 6-24 hours increases the risk for renal injury. The aim of this study was to evaluate the starting dose of norepinephrine on renal outcomes in patients with septic shock. Methods: This was a retrospective, single center cohort study from January 2008 to June 2018. Patients were identified through their ICD 9/10 codes for sepsis and septic shock and cross referenced to confirm diagnosis within the electronic medical record. Patients were stratified into those that developed a need for renal replacement therapy (RRT) and those that did not. Baseline and outcome comparisons were made between groups. Univariate analysis was completed to evaluate outcomes that were significantly associated with the development of RRT. Logistic regression models were used to evaluate predictors for the need for RRT and mortality. Results: A total of 70 patients were evaluated for inclusion in our analysis. Eleven patients required dialysis at baseline and were excluded. Out of the remaining 59 patients, 22 patients required RRT in the ICU while 37 patients did not require RRT. The starting dose of norepinephrine (NE) was lower in those patients that required RRT (0.05 ± 0.025 mcg/kg/min vs 0.08 ± 0.055 mcg/kg/min; p=0.018). Patients that required RRT were less likely to meet their MAP goal at 4 hours (27.3% vs 54.1%; p=0.045), more likely to require an additional vasopressor (90.9% vs 29.7%; p=<0.0001), and had lower survival rates (40.9% vs 78.4%; p=0.004). Starting dose of vasopressors was significantly and inversely associated with the need for RRT (OR of 0.74 [95% CI 0.557-0.981]; p=0.036). The need for RRT was associated with increased mortality (OR of 6.02 [95% CI 1.29-27.8]; p=0.022). Conclusions: Septic shock patients that developed a need for RRT were initiated at a lower dose of NE. Starting dose of NE was an independent predictor of developing RRT. Developing the need for RRT was an independent predictor of mortality. Our study supports the need for prospective studies comparing high versus low starting doses of vasopressors in septic shock.