Vasopressin in septic shock; assessment of sepsis biomarkers: A randomized, controlled trial

Abstract

Background and Aims:Vasopressin (VP) in sepsis apart from vasoconstrictive effect may have some immunomodulatory effects. The aim of this study was to evaluate the effect of VP on different aspect of sepsis by measuring of sepsis biomarkers.Materials and Methods:In this trial, a total number of 42 septic shock patients were included. The first group received norepinephrine (NE) infusion to reach the target mean arterial pressure (MAP) of ≥ 65 mm Hg and the second group received arginine vasopressin (AVP) infusion in addition to NE. Serum lactate, C-reactive protein (CRP), interleukin-6 (IL-6), IL-10, pentraxin 3 (PTX3), angiopoietin 1 and 2 (Ang 1 and 2) levels were assessed.Results:Level of IL-6 and IL-10 decreased, but there was no significant difference between the two groups after 48 h. CRP and PTX3 levels were not also significantly different between groups. Although Angs were not statistically different, there was a trend toward higher Ang-1 in and lower Ang 2 in AVP group after 24 and 48 h. In addition, lactate level did not differ between NE and AVP groups. There was no interaction between VP and hydrocortisone use on IL-6, IL-10, and PTX3, but a significant statistical interaction on Ang 1 and Ang 2 were observed.Conclusions:Although analysis of sepsis biomarkers showed no significant difference between two groups, no immunomodulatory effect for VP alone, subgroup analysis of hydrocortisone used in this study showed that the combination of glucocorticoids and AVP had a significant effect on Angs level which eventually causes less endothelial permeability and higher MAP in this group of patients.

The Efficacy and Safety of Vasopressors for Septic Shock Patients: A Systemic Review and Network Meta-Analysis

“…We included 38 trials from the database search and 9 unpublished studies from trial registries or other methods. Ultimately, 47 RCTs (comprising 7,798 patients) (10–56) performed between 1993 and 2021 were included. Twenty-one types of vasoactive agents were compared in the included trials, including single administration of NE, EP, enoximone (EX), dopexamine (DX), dobutamine (DB), dopamine (DA), levosimendan (LE), vasopressin (VP), TP, SP, phenylephrine (PE), placebo (PA) and other catecholamines (CE), as well as combined therapies including NE plus DB (NE_DB), NE plus DX (NE_DX), NE plus EP (NE_EP), NE plus TP (NE_TP), NE plus VP (NE_VP), TP plus DB (TE_DB), and TP plus CE (TP_CE).…”