AUTHOR=Casarotta Erika , Damiani Elisa , Domizi Roberta , Carsetti Andrea , Scorcella Claudia , Adrario Erica , Bolognini Sandra , Di Falco Domenico , Pantanetti Simona , Vannicola Sara , Damia Paciarini Agnese , Donati Abele 

TITLE=Variation in the Outcome of Norepinephrine-Dependent Septic Patients After the Institution of a Patient-Tailored Therapy Protocol in an Italian Intensive Care Unit: Retrospective Observational Study

JOURNAL=Frontiers in Medicine

VOLUME=7

YEAR=2020

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2020.592282

DOI=10.3389/fmed.2020.592282

ISSN=2296-858X

ABSTRACT=<p><bold>Objective:</bold> To evaluate the outcome of patients with septic shock after the institution of a <italic>patient tailored therapy</italic> protocol in our Intensive Care Unit (ICU).</p><p><bold>Methods:</bold> Single-center retrospective observational study including 100 consecutive septic patients (≥ 16 years) requiring norepinephrine infusion, admitted to our ICU between 2018 and 2019 after the institution of a <italic>patient-tailored therapy</italic> protocol, compared with a historical control group of 100 patients admitted between 2010 and 2013 (<italic>historical controls</italic>). The <italic>patient-tailored therapy</italic> protocol included the use of IgM-enriched immunoglobulins for patients with low plasma IgM levels, blood purification strategies for patients with high plasma levels of cytokines or endotoxin, albumin correction and modulation of vasoactive agents. Clinical and therapeutic parameters were noted at the time of initiation of norepinephrine infusion and for the 1st 24 h. The primary outcome was ICU mortality.</p><p><bold>Results:</bold> ICU-mortality was lower in the patient-tailored therapy cohort as compared to historical controls (32 vs. 57%, <italic>p</italic> &lt; 0.001). Patient-tailored therapy was associated with a lower risk of ICU-mortality even after adjusting for the main clinical severity indices (adjusted odds ratio 0.331 [95% confidence interval 0.166–0.658], <italic>p</italic> = 0.002). After propensity score matching, 48 patients in historical control group and 48 patients in the patient-tailored therapy cohort with similar general characteristics were selected. ICU-mortality was lower in the patient-tailored therapy matched subgroup as compared to historical controls (40 vs. 60%, <italic>p</italic> = 0.037).</p><p><bold>Conclusions:</bold> An individualized therapeutic approach in septic patients may be associated with a survival benefit. However, the use of an historical control group of patients admitted between 2010 and 2013 may introduce substantial bias. Further adequately designed studies are needed to demonstrate the impact of <italic>patient-tailored therapy</italic> on outcome.</p>