Risk factors for mortality in septic patients who received etomidate

Rech, Megan A.; Bennett, Stephanie; Chaney, Whitney; Sterk, Ethan

doi:10.1016/j.ajem.2015.07.062

Cited by 7 publications

(3 citation statements)

References 19 publications

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“…This study, to the best of our knowledge, is the first that specifically aimed to identify pre-intubation risk factors of mortality in septic patients who were intubated with RSI using single-dose etomidate in the ED. A previous retrospective study conducted in an ED and intensive care units reported that multiple vasopressors and intra-abdominal infection were associated with increased mortality in patients receiving etomidate [ 18 ]. However, the study did not clearly distinguish pre-intubation factors from other variables, which may have limited utility in the emergency setting.…”

Section: Discussionmentioning

confidence: 99%

Independent risk factors of mortality in patients with sepsis receiving single-dose etomidate as an induction agent during rapid sequence intubation in a large tertiary emergency department in Thailand

et al. 2022

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Background There is limited evidence regarding factors associated with mortality in septic patients receiving etomidate. This study aimed to determine independent pre-intubation factors predicting 28-day mortality in septic patients receiving single-dose etomidate as an induction agent during rapid sequence intubation (RSI). Methods This single-center retrospective cohort study included intubated septic patients receiving etomidate as an induction agent during RSI in the emergency department of Siriraj hospital, Bangkok, Thailand, between January 1st, 2016 and June 30th, 2020. Pre-intubation characteristics were compared between survivors and non-survivors. Independent risk factors associated with 28-day mortality were identified using the Cox proportional hazards regression model. Association between etomidate dosage and mortality was also determined. Results A total of 344 patients, 238 (69%) survivors and 106 (31%) non-survivors, were included in the analyses. The initial Cox hazards model identified a pre-intubation lactate level ≥ 4 mmol/L as an independent factor associated with mortality (adjusted Hazards ratio [aHR] 2.66, 95% confidence interval [CI] 1.55–4.56). After removing lactate level from the model due to limited lactate values in the data, cancer was also predictive of 28-day mortality (aHR 1.83, 95%CI 1.10–3.04), while patients with respiratory infections and underlying chronic lung disease were associated with lower mortality (aHR 0.54, 95%CI 0.37–0.80 and aHR 0.57, 0.33–0.96, respectively). Etomidate dosage was not associated with mortality in our study. Conclusion In septic patients who received a single dose of etomidate, a pre-intubation lactate level ≥ 4 mmol/L and cancer were associated with increased 28-day mortality, while respiratory infection and underlying chronic lung disease were associated with lower mortality. Physicians may take these factors into consideration when selecting induction agents for septic patients.

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Section: Discussionmentioning

confidence: 99%

Independent risk factors of mortality in patients with sepsis receiving single-dose etomidate as an induction agent during rapid sequence intubation in a large tertiary emergency department in Thailand

et al. 2022

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“…While medical scientists and clinical experts agree that certain key factors can serve as prognostic indicators for sepsis, 13 different studies have identified varying high-risk factors. 14 , 15 In our study, we examined data from a cohort of 1733 septic patients and identified ten variables (MV requirement, HF requirement, NE requirement, Septicemia, MDR, thrombocytopenia, RDW-CV, CRP, AT III, and APTT) that exhibited the strongest associations with sepsis-related mortality using Lasso regression.…”

Section: Discussionmentioning

confidence: 99%

LASSO-Based Identification of Risk Factors and Development of a Prediction Model for Sepsis Patients

Hong,

Xiong,

Xia

et al. 2024

TCRM

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Objective The objective of this study was to utilize LASSO regression (Least Absolute Shrinkage and Selection Operator Regression) to identify key variables in septic patients and develop a predictive model for intensive care unit (ICU) mortality. Methods We conducted a cohort consisting of septic patients admitted to the ICU between December 2016 and July 2019. The disease severity and laboratory index were analyzed using LASSO regression. The selected variables were then used to develop a model for predicting ICU mortality. AUCs of ROCs were applied to assess the prediction model, and the accuracy, sensitivity and specificity were calculated. Calibration were also used to assess the actual and predicted values of the predictive model. Results A total of 1733 septic patients were included, among of whom 382 (22%) died during ICU stay. Ten variables, namely mechanical ventilation (MV) requirement, hemofiltration (HF) requirement, norepinephrine (NE) requirement, septicemia, multiple drug-resistance infection (MDR), thrombocytopenia, hematocrit, red-cell deviation width coefficient of variation (RDW-CV), C-reactive protein (CRP), and antithrombin (AT) III, showed the strongest association with sepsis-related mortality according to LASSO regression. When these variables were combined into a predictive model, the area under the curve (AUC) was found to be 0.801. The AUC of the validation group was 0.791. The specificity of the model was as high as 0.953. Within the probability range of 0.25 to 0.90, the predictive performance of the model surpassed that of individual predictors within the cohort. Conclusion Our findings suggest that a predictive model incorporating the variables of MV requirement, HF requirement, NE requirement, septicemia, MDR, thrombocytopenia, HCT, RDW-CV, CRP, and AT III exhibiting an 80% likelihood of predicting ICU mortality in sepsis and demonstrates high accuracy.

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“…However, it decreased to 9% at 48 hours and to 7% at 72 hours [8]. While several studies have implicated etomidate in causing increased mortality and AI in critically ill patients [9][10][11][12], other studies found that etomidate use in patients with severe sepsis and septic shock was correlated with decreased mortality [13,14].…”

Section: Introductionmentioning

confidence: 99%

Association between Etomidate Use for Rapid Sequence Intubation and Adrenal Insufficiency in Sepsis

Cagliani¹,

Ruhemann²,

Molmenti³

et al. 2021

Cureus

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Background The risk of adrenal insufficiency (AI) in using single-dose etomidate for intubation among patients with sepsis remains controversial. Our aim was to assess the prevalence of AI and characterize the risk factors in patients who received etomidate for rapid sequence intubation (RSI). Methods This is a retrospective study of prospectively-acquired data evaluating surgical intensive care unit (SICU) patients who developed respiratory failure undergoing RSI. Results Of the 44 adult SICU patients who developed respiratory failure, 34 patients received etomidate. The average age for the total cohort, for the patients that received etomidate and for those who did not, was 70.91 ± 14.92, 72.82 ± 13.61 years and 64.40 ± 15.93, respectively. Twenty-four patients of the total cohort (54.55%) developed AI; 26 had septic shock (59.09%), and 16 patients had AI and septic shock (36.36%). There was no statistical significance between the incidence of AI in patients who received etomidate (47%) and those who did not (80%). However, in the subset of patients who received etomidate for RSI, there was a nonsignificant trend toward increased incidence of AI in those who were septic compared to those who were not (p = 0.06). Conclusion A single dose of etomidate used for RSI in SICU patients is not associated with the development of AI or mortality. However, a trend was shown, although not statistically significant, towards the development of AI in septic patients. High-quality and adequately powered randomized control trials (RCTs) are warranted.

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Risk factors for mortality in septic patients who received etomidate

Cited by 7 publications

References 19 publications

Independent risk factors of mortality in patients with sepsis receiving single-dose etomidate as an induction agent during rapid sequence intubation in a large tertiary emergency department in Thailand

Independent risk factors of mortality in patients with sepsis receiving single-dose etomidate as an induction agent during rapid sequence intubation in a large tertiary emergency department in Thailand

LASSO-Based Identification of Risk Factors and Development of a Prediction Model for Sepsis Patients

Association between Etomidate Use for Rapid Sequence Intubation and Adrenal Insufficiency in Sepsis

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