Risk Factors of Vasopressor-Induced Symmetrical Peripheral Gangrene

Abstract

BackgroundSymmetrical peripheral gangrene (SPG) is an uncommon syndrome showing symmetrical gangrene in acral regions without evidence of large-vessel occlusion or vasculitis. Intravenous vasopressors are frequently used to manage hemodynamically unstable patients. There have been few reports about SPG after using inotropics. However, risk factors for SPG have not been extensively studied. Therefore, the objective of this study was to analyze several cases of SPG and identify risk factors for SPG.MethodsFrom October 2013 to October 2016, 36 patients with SPG after using vasopressors were included in this study. SPG is an extremely rare disease entity. Therefore, this work was designed as a matched case-control study. For the control group, 42 patients (25 men and 17 women) with similar age, admission department, sex, and vasopressor usage in intensive care unit patients during the same period were selected. Retrospective chart review was performed to identify risk factors within the following categories: medical conditions, vasopressor-related factors, and Sequential Organ Failure Assessment scores.ResultsDifferences between the 2 groups concerning medical condition-related variables did not exist. Statistically significant differences were found in intensive care unit duration (P = 0.0011) and survival. All vasopressor-related factors were adjusted according to weights of patients. Weight-compensated mean dose of dopamin significantly (P = 0.028) affected the occurrence of SPG. Weight-compensated peak dose of norpin, dopamin, and epinephrine also significantly contributed to SPG.ConclusionsSymmetrical peripheral gangrene is a rare clinical syndrome related with a high mortality and up to 70% of patients who survive require amputation. Several studies have mentioned that there are several factors affecting the result of SPG. Few studies on SPG have been reported and most of them are case reports. In this study, we revealed the influence of vasopressors to the occurrence of SPG, and this was the first matched case-control study based on the analysis of multiple risk factors.

Analysis of Characteristics of Peripheral Arterial Ischemia in Premature Babies and Effects of Nitroglycerin Patch Application

“…This study found a significant difference in the use of inotropic agents, similar to the findings of domestic and international studies on limb necrosis due to vasoconstrictive agents and inotropic agents [23,24]. Blood pressure was measured on the third day after birth, after 72 hours when the PDA was closed; it was found that the blood pressure of premature newborns with peripheral arterial ischemia was significantly more likely to be in the 50th percentile or lower.…”

Botulinum Toxin in the Treatment of Vasopressor-associated Symmetric Peripheral Gangrene

“…The use of vasopressors compounds the risk of ischemia in patients with disseminated intravascular coagulation by inducing vasoconstriction in the setting of underlying hematologic dysregulation. 3 , 5 BT may alleviate the local effect of vasopressors to improve tissue oxygenation. A prospective trial was initiated in 2011 to study the use of BT in vasopressor-induced digital ischemia, although it was terminated due to low accrual.…”

Incidence and associated risk factors for limb amputation among sepsis survivors in South Korea

“…Furthermore, patients with sepsis treated with epinephrine and dopamine in our study may have been refractory to norepinephrine, suggesting that they had a more severe status. Moreover, results of a multivariable model used in a recent retrospective cohort study reported that only dopamine among all the vasopressors, was associated with PG development in ICU patients [ 26 ].…”