Early vasopressin use was not associated with major adverse kidney events at 30 days in adults requiring vasopressors after cardiac surgery (OR 1.02; 95% CI 0.76-1.38; p=0.88).
Cohort (n=3,753)
Yes
Does vasopressin use within 24 hours of ICU admission reduce major adverse kidney events at 30 days in adults requiring vasopressor support after cardiac surgery?
Early adjunctive vasopressin use in patients requiring vasopressor support after cardiac surgery is not associated with a reduction in major adverse kidney events or mortality at 30 days.
Odds Ratio: 1.02 (95% CI 0.76–1.38)
p-value: p=0.88
OBJECTIVES: To examine whether early vasopressin use was associated with major adverse kidney events in patients requiring vasopressor support after cardiac surgery. DESIGN: A multicenter retrospective cohort study using inverse probability of treatment weighting with overlap weights. SETTING: Four intensive care units in Queensland, Australia (2015-2021). PARTICIPANTS: A total of 3,753 adults admitted after cardiac surgery (coronary artery bypass grafting, valve surgery, or combined procedures) requiring 6 or more consecutive hours of vasopressor support within the first 24 hours. Patients receiving extracorporeal membrane oxygenation were excluded. INTERVENTIONS: Vasopressin use within 24 hours of intensive care unit admission versus no vasopressin. MEASUREMENTS AND MAIN RESULTS: The primary outcome was major adverse kidney events at 30 days, a composite of death, new renal replacement therapy, or creatinine doubling. Of 3,753 patients, 603 (16.1%) received vasopressin. After weighting, vasopressin was not associated with major adverse kidney events at 30 days (odds ratio OR 1.02, 95% confidence interval CI 0.76-1.38, p = 0.88). No differences were observed for 30-day mortality (OR 1.12, 95% CI 0.69-1.82), acute kidney injury within 7 days (OR 1.04, 95% CI 0.85-1.28), or new renal replacement therapy (OR 1.19, 95% CI 0.80-1.76). A significant interaction was observed for illness severity (p = 0.004), with a trend toward benefit in the highest-severity tertile. CONCLUSIONS: Adjunctive vasopressin use was not associated with major adverse kidney events or mortality in patients requiring vasopressors after cardiac surgery. Heterogeneity of treatment effect by illness severity warrants prospective evaluation.
White et al. (Wed,) conducted a cohort in Requiring vasopressor support after cardiac surgery (n=3,753). Vasopressin vs. No vasopressin was evaluated on Major adverse kidney events at 30 days (composite of death, new renal replacement therapy, or creatinine doubling) (OR 1.02, 95% CI 0.76-1.38, p=0.88). Early vasopressin use was not associated with major adverse kidney events at 30 days in adults requiring vasopressors after cardiac surgery (OR 1.02; 95% CI 0.76-1.38; p=0.88).