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J Korean Soc Emerg Med > Volume 30(6); 2019 > Article
Journal of The Korean Society of Emergency Medicine 2019;30(6): 529-536.
Short-term hemodynamic response to calcium supplementation in patients with refractory septic shock: a retrospective observational study
Han Sol Chang , Sung Yeon Hwang , Jong Eun Park , Taerim Kim , Joo Hyun Park , Hee Yoon , Won Chul Cha , Min Seob Sim , Ik Joon Jo , Tae Gun Shin
Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Correspondence  Tae Gun Shin ,Tel: 02-3410-2053, Fax: 02-3410-0012, Email: taegunshin@skku.edu,
Received: April 2, 2019; Revised: July 2, 2019   Accepted: September 11, 2019.  Published online: December 31, 2019.
ABSTRACT
Objective:
Research on calcium use as an adjunctive rescue therapy for refractory septic shock is limited. In this study, we aimed to investigate the short-term hemodynamic response after calcium supplementation in patients with refractory septic shock.
Method:
This was a single-center, retrospective study of patients who presented to the Emergency Department from October 2014 through February 2018. Patients with refractory septic shock requiring norepinephrine-equivalent (NE) dose ≥ 0.5 μg/kg/min and receiving calcium supplementation, were included in the analysis. Patients were categorized into response group and no-response group, based on the changes in NE doses and mean arterial pressure after calcium administration. A multivariable logistic regression model was used to evaluate the association between hemodynamic response and 28-day survival.
Results:
A total of 66 patients were included in the study. Of these, 34 patients (52%) were classified as the response group, and 32 patients (48%) encompassed the no-response group (17 patients who deteriorated and 15 patients who had no significant changes in the clinical status). The 28-day mortality was determined to be 44% in the response group and 63% in the no-response group (P=0.14). Multivariable analysis revealed that the response group had a significant association with lower 28-day mortality (adjusted odds ratio, 0.23; 95% confidence interval, 0.06-0.89; P=0.03).
Conclusion:
Short-term hemodynamic changes after calcium administration were variable in patients with refractory septic shock. Hemodynamic improvement after calcium supplementation may be associated with better survival. Further studies are required to determine when calcium supplementation needs to be considered, and how it impacts patientcentered outcomes in refractory septic shock.
Key words: Calcium; Septic shock; Refractory shock; Vasopressor therapy; Hypotension
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