Vasopressin compared with norepinephrine augments the decline of plasma cytokine
levels in septic shock.
Author(s): Russell JA(1), Fjell C, Hsu JL, Lee T, Boyd J, Thair S, Singer J, Patterson AJ,
Walley KR.
Affiliation(s): Author information:
(1)James Hogg Research Centre, St. Paul's Hospital, University of British Columbia,
Vancouver, British Columbia, Canada. jim.russell@hli.ubc.ca
Publication date & source: 2013, Am J Respir Crit Care Med. , 188(3):356-64
RATIONALE: Changes in plasma cytokine levels may predict mortality, and therapies
(vasopressin versus norepinephrine) could change plasma cytokine levels in early
septic shock.
OBJECTIVES: Our hypotheses were that changes in plasma cytokine levels over 24
hours differ between survivors and nonsurvivors, and that there are different
effects of vasopressin and norepinephrine on plasma cytokine levels in septic
shock.
METHODS: We studied 394 patients in a randomized, controlled trial of vasopressin
versus norepinephrine in septic shock. We used hierarchical clustering and
principal components analysis of the baseline cytokine concentrations to subgroup
cytokines; we then compared survivors to nonsurvivors (28 d) and compared
vasopressin- versus norepinephrine-induced changes in cytokine levels over 24
hours.
MEASUREMENTS AND MAIN RESULTS: A total of 39 plasma cytokines were measured at
baseline and at 24 hours. Hierarchical clustering and principal components
analysis grouped cytokines similarly. Survivors (versus nonsurvivors) had greater
decreases of overall cytokine levels (P < 0.001). Vasopressin decreased overall
24-hour cytokine concentration compared with norepinephrine (P = 0.037). In less
severe septic shock, the difference in plasma cytokine reduction over 24 hours
between survivors and nonsurvivors was less pronounced than that seen in more
severe septic shock. Furthermore, vasopressin decreased interferon-inducible
protein 10 and granulocyte colony-stimulating factor more than did norepinephrine
in less severe septic shock, whereas vasopressin decreased granulocyte-macrophage
colony-stimulating factor in patients who had more severe shock.
CONCLUSIONS: Survivors of septic shock had greater decreases of cytokines,
chemokines and growth factors in early septic shock. Vasopressin decreased
24-hour plasma cytokine levels more than did norepinephrine. The
vasopressin-associated decrease of cytokines differed according to severity of
shock. Clinical trial registered with www.controlled-trials.com (ISRCTN94845869).
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