Open Access Research article

Etomidate and mortality in cirrhotic patients with septic shock

Antoine J Cherfan1, Hani M Tamim2, Abdulrahman AlJumah3, Asgar H Rishu4, Abdulmajeed Al-Abdulkareem5, Bandar A Al Knawy6, Ali Hajeer7, Waleed Tamimi8, Riette Brits4 and Yaseen M Arabi9*

Author Affiliations

1 Pharmaceutical Care Department, Clinical Pharmacy Division, King Abdulaziz Medical City, Riyadh, Saudi Arabia

2 Epidemiology and Biostatistics, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

3 Hepatobiliary Sciences & Liver Transplantation Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia

4 Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia

5 Hepatobiliary Sciences & Liver Transplantation Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia

6 Division of Gastroenterology and Hepatology, Department of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia

7 Division of Immunology, Laboratory and Pathology, Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia

8 Division of Clinical Chemistry, Department of Pathology & Lab Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia

9 Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia

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BMC Clinical Pharmacology 2011, 11:22  doi:10.1186/1472-6904-11-22

Published: 30 December 2011

Abstract

Background

Clinical effects and outcomes of a single dose etomidate prior to intubation in the intensive care setting is controversial. The aim of this study is to evaluate the association of a single dose effect of etomidate prior to intubation on the mortality of septic cirrhotic patients and the impact of the subsequent use of low dose hydrocortisone.

Methods

This is a nested-cohort study within a randomized double blind placebo controlled study evaluating the use of low dose hydrocortisone in cirrhotic septic patients. Cirrhotic septic patients ≥ 18 years were included in the study. Patients who received etomidate prior to intubation were compared to those who did not receive etomidate for all cause 28-day mortality as a primary outcome.

Results

Sixty two intubated patients out of the 75 patients randomized in the initial trial were eligible for this study. Twenty three of the 62 intubated patients received etomidate dose prior to intubation. Etomidate use was not associated with all cause 28-day mortality or hospital mortality but was associated with significantly higher ICU mortality (91% vs. 64% for etomidate and controls groups, respectively; p = 0.02). Etomidate patients who received subsequent doses of hydrocortisone required lower doses of vasopressors and had more vasopressor-free days but no improvement in mortality.

Conclusions

In this group of septic cirrhotic patients with very high mortality, etomidate increased ICU mortality. Subsequent use of hydrocortisone appears to have no benefit beyond decreasing vasopressor requirements. The lowest mortality was observed in patients who did not receive etomidate but received hydrocortisone.