Andrew J. Patterson, M.D., Ph.D.

Publication Details

  • Vasopressin Compared with Norepinephrine Augments the Decline of Plasma Cytokine Levels in Septic Shock AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE Russell, J. A., Fjell, C., Hsu, J. L., Lee, T., Boyd, J., Thair, S., Singer, J., Patterson, A. J., Walley, K. R. 2013; 188 (3): 356-364


    Changes in plasma cytokine levels may predict mortality and therapies (vasopressin versus norepinephrine) could change plasma cytokine levels in early septic shock.Our hypotheses were that changes in plasma cytokine levels over 24 hours differ between survivors and non-survivors and there are different effects of vasopressin vs. norepinephrine on plasma cytokine levels in septic shock.We studied 394 patients in a randomized, controlled trial of vasopressin vs. norepinephrine in septic shock. We used hierarchical clustering and principal components analysis (PCA) of the baseline cytokine concentrations to subgroup cytokines; we then compared survivors to non-survivors (28-day) and compared vasopressin- vs. norepinephrine-induced changes in cytokine levels over 24 hours.Thirty-nine plasma cytokines were measured at baseline and 24 hours. Hierarchical clustering and PCA grouped cytokines similarly. Survivors (vs. non-survivors) had greater decreases of overall cytokine levels (p < 0.001). Vasopressin decreased overall 24-hour cytokine concentration compared to norepinephrine (p = 0.037). In less severe septic shock, the difference in plasma cytokine reduction over 24 hours between survivors and non-survivors was less pronounced than seen in more severe septic shock. Furthermore, vasopressin decreased IP-10 and GCSF more than did norepinephrine in less severe septic shock, whereas vasopressin decreased GMCSF in patients who had more severe shock.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.

    View details for DOI 10.1164/rccm.201302-0355OC

    View details for Web of Science ID 000322617800017

    View details for PubMedID 23796235

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