Clinical Characteristics and Outcomes of Patients Requiring Vasopressor Support in the critical care settings

Abstract

Background: Vasopressor therapy is an essential component of the management of critically ill patients with circulatory shock in the intensive care unit (ICU). The requirement for vasopressor support is generally associated with severe illness, multiple organ dysfunction, prolonged ICU stay, and increased mortality. Limited data are available regarding the clinical characteristics and outcomes of patients receiving vasopressors in resource-limited healthcare settings. Objective: To evaluate the clinical characteristics, indications, complications, and outcomes of patients requiring vasopressor support in the ICU of District Headquarter (DHQ) Hospital Mansehra. Methodology: A hospital-based prospective observational study was conducted in the ICU of DHQ Hospital Mansehra, Pakistan, over a six-month period from 15 February 2023 to 30 August 2023. A total of 250 consecutive adult patients requiring vasopressor therapy were enrolled. Demographic characteristics, clinical variables, vasopressor utilization, complications, and patient outcomes were prospectively recorded using a standardized data collection form. Data were analyzed using IBM SPSS Statistics version 25.0. Continuous and categorical variables were analyzed using appropriate statistical tests, and multivariable logistic regression was performed to identify independent predictors of ICU mortality. A p-value <0.05 was considered statistically significant. Results: The mean age of the patients was 56.8 ± 17.2 years, and 59.2% were male. Septic shock was the most common indication for vasopressor therapy (43.2%), followed by cardiogenic shock (20.8%) and hypovolemic shock (15.2%). Norepinephrine was the most frequently administered vasopressor (79.2%). Mechanical ventilation was required in 68.8% of patients, while 16.4% underwent renal replacement therapy. Vasopressor-related complications occurred in 39.2% of patients, with acute kidney injury (23.2%) being the most common complication. The overall ICU mortality was 35.6%. Non-survivors had significantly higher SOFA and APACHE II scores, longer duration of vasopressor therapy, greater need for mechanical ventilation, and a higher incidence of acute kidney injury compared with survivors (p <0.001). Conclusion: Patients requiring vasopressor support in the ICU experience considerable morbidity and mortality, with septic shock being the leading indication for therapy. Higher illness severity, prolonged vasopressor use, mechanical ventilation, and acute kidney injury were significant predictors of poor outcomes. Early recognition of shock and prompt evidence-based hemodynamic management may improve survival in critically ill patients.