Late vasopressor administration in ICU patients: A retrospective cohort study

Abstract Background Little is known about the prevalence, predictors, and outcomes of late vasopressor administration which evolves after admission to the ICU. Methods We retrospectively studied a cohort of Veterans admitted to the Veterans Administration ICUs for ≥ 4 days from 2014–2017. The timing of vasopressor administration was categorized as early (only within the initial 3 days), late (on ≥ day 4 and none on day 3) and continuous (within the initial 2 days through at least day 4). Regressions were performed to identify patient factors associated with late vasopressor administration and the timing of vasopressor administration with post-hospitalization discharge mortality. Results Among the 62,206 hospitalizations with at least 4 ICU days, late vasopressor administration occurred in 5.5% (N=3,429/62,206). Patients with greater co-morbidities (aOR: 1.02 per van Walraven point, 95% CI: 1.02-1.03) and worse severity of illness on admission (aOR: 1.01 per percentage-point risk of death, 95% CI: 1.01-1.02) were more likely to receive late vasopressor therapy. Nearly 50% of patients started a new antibiotic within 24 hours of receiving late vasopressor therapy. One-year mortality after survival to discharge was higher for patients with continuous (aHR: 1.48 95% CI: 1.33-1.65) and late vasopressor administration (aHR: 1.26 95% CI: 1.15-1.38) as compared to only early vasopressor administration. Conclusions Late vasopressor administration was modestly associated with co-morbidities and admission illness severity. One-year mortality was higher among those who received late vasopressor administration as compared to only early vasopressor administration. Research to understand optimization of late vasopressor therapy administration may improve long-term mortality.