• Pedro R Póvoa, António H Carneiro, Orquídea S Ribeiro, Altamiro C Pereira, and Portuguese Community-Acquired Sepsis Study Group.
• Medical Intensive Care Unit, São Francisco Xavier Hospital, Lisbon, Portugal. povoap@netcabo.pt
• Crit. Care Med. 2009 Feb 1;37(2):410-6.

ObjectiveGuidelines for the adrenergic support of septic shock are controversial. In patients with community-acquired septic shock, we assessed the impact of the choice of vasopressor support on mortality.DesignCohort, multiple center, observational study.SettingSeventeen Portuguese intensive care units (ICUs).PatientsAll adult patients admitted to a participating ICU between December 2004 and November 2005.InterventionsNone.Measurements And Main ResultsPatients were followed up during the first five ICU days, the day of discharge or death, and hospital outcome. Eight hundred ninety-seven consecutive patients with community-acquired sepsis (median age, 63 years; 577 men; and hospital mortality, 38%) were studied. Of the 458 patients with septic shock, 73% received norepinephrine and 50.5% dopamine. The norepinephrine group had a higher hospital mortality (52% vs. 38.5%, p = 0.002). A Kaplan-Meier survival curve showed diminished 28-day survival in the norepinephrine group (log-rank = 22.6, p < 0.001). A Cox proportional hazard analysis revealed that the administration of norepinephrine was associated with an increased risk of death (adjusted hazard ratio, 2.501; 95% confidence interval, 1.413-4.425; p = 0.002). In a multivariate analysis with ICU mortality as the dependent factor, Simplified Acute Physiology Score II and norepinephrine administration were independent risk factors for ICU mortality in patients with septic shock.ConclusionsIn patients with community-acquired septic shock, our data suggest that norepinephrine administration could be associated with worse outcome.

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