Vasopressin Administration Is Associated With Rising Serum Lactate Levels in Patients With Sepsis

• Published in: Journal of intensive care medicine 2020-09, Vol.35 (9), p.881-888
• Main Authors: Severson, Kristen A., Ritter-Cox, Laura, Raffa, Jesse D., Celi, Leo Anthony, Gordon, William J.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antidiuretic Agents - administration & dosage; Antidiuretic Agents - adverse effects; Case-Control Studies; Critical Care; Drug Therapy, Combination; Female; Humans; Intensive Care Units; Lactic Acid - blood; Male; Middle Aged; Norepinephrine - administration & dosage; Odds Ratio; Retrospective Studies; Sepsis - blood; Sepsis - drug therapy; Treatment Outcome; Vasopressins - administration & dosage; Vasopressins - adverse effects
• ISSN: 0885-0666; 1525-1489
• DOI: 10.1177/0885066618794925

Background: Vasopressin is used in conjunction with norepinephrine during treatment of patients with septic shock. Serum lactate is often used in monitoring of patients with sepsis; however, its importance as a therapeutic target is unclear. The objective of this study is to examine the relationship of vasopressin use on serum lactate levels in patients with sepsis. Methods: This study uses electronic heath records available via the Medical Information Mart for Intensive Care III. Patients were required to have a serum lactate monitoring during the intensive care unit (ICU) stay. The treatment was the administration of vasopressin between hours 3 and 18 of the ICU stay. Analysis was performed using a matched design. Results: Patients receiving vasopressin were more likely to have their serum lactate levels rise when compared to matched patients who did not receive vasopressin (odds ratio: 6.6; 95% confidence interval: 3.0-14.6, P < .001). Patients who received vasopressin had a median increase in serum lactate of 0.3 mmol/L, while patients who did not receive vasopressin had a median decrease in serum lactate of 0.7 mmol/L (P < .001). There was no statistically significant difference between the control and treated groups’ lactate trajectories prior to possible administration of vasopressin (P = .15). The results did not change significantly when norepinephrine initiation was used as the index time. Conclusions: In patients with sepsis, the administration of vasopressin was associated with a statistically significant difference in lactate change over the course of 24 hours when compared to matched patients who did not receive vasopressin.