***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: AIMS Systolic dysfunction in septic shock is well recognized and , paradoxically , predicts better outcome . In contrast , diastolic dysfunction is often ignored and its role in determining early mortality from sepsis has not been adequately investigated . METHODS AND RESULTS A cohort of 262 intensive care unit patients with severe sepsis or septic shock underwent two echocardiography examinations early in the course of their disease . All clinical , laboratory , and survival data were prospect ively collected . Ninety-five ( 36 % ) patients died in the hospital . Reduced mitral annular e'-wave was the strongest predictor of mortality , even after adjusting for the APACHE-II score , low urine output , low left ventricular stroke volume index , and lowest oxygen saturation , the other independent predictors of mortality ( Cox 's proportional hazards : Wald = 21.5 , 16.3 , 9.91 , 7.0 and 6.6 , P < 0.0001 , < 0.0001 , 0.002 , 0.008 , and 0.010 , respectively ) . Patients with systolic dysfunction only ( left ventricular ejection fraction ≤50 % ) , diastolic dysfunction only ( e'-wave < 8 cm/s ) , or combined systolic and diastolic dysfunction ( 9.1 , 40.4 , and 14.1 % of the patients , respectively ) had higher mortality than those with no diastolic or systolic dysfunction ( hazard ratio = 2.9 , 6.0 , 6.2 , P= 0.035 , < 0.0001 , < 0.0001 , respectively ) and had significantly higher serum levels of high-sensitivity troponin-T and N-terminal pro-B-type natriuretic peptide ( NT-proBNP ) . High-sensitivity troponin-T was only minimally elevated , whereas serum levels of NT-proBNP were markedly elevated [ median ( inter-quartile range ) : 0.07 ( 0.02 - 0.17 ) ng/mL and 5762 ( 1001 - 15 962 ) pg/mL , respectively ] , though both predicted mortality even after adjusting for highest creatinine levels ( Wald = 5.8 , 21.4 and 2.3 , P= 0.015 , < 0.001 and 0.13 ) . CONCLUSION Diastolic dysfunction is common and is a major predictor of mortality in severe sepsis and septic shock Objectives : To describe the quality of life among sepsis survivors . Design : Secondary analyses of two international , r and omized clinical trials ( A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis [ derivation cohort ] and PROWESS-SHOCK [ validation cohort ] ) . Setting : ICUs in North and South America , Europe , Africa , Asia , and Australia . Patients : Adults with severe sepsis . We analyzed only patients who were functional and living at home without help before sepsis hospitalization ( n = 1,143 and 987 from A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis and PROWESS-SHOCK , respectively ) . Interventions : None . Measurements and Main Results : In A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis and PROWESS-SHOCK , the average age of patients living at home independently was 63 and 61 years ; 400 ( 34.9 % ) and 298 ( 30.2 % ) died by 6 months . In A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis , 580 patients had a  quality of life measured using EQ-5D at 6 months . Of these , 41.6 % could not live independently ( 22.7 % were home but required help , 5.1 % were in nursing home or rehabilitation facilities , and 5.3 % were in acute care hospitals ) . Poor quality of life at 6 months , as evidence d by problems in mobility , usual activities , and self-care domains were reported in 37.4 % , 43.7 % , and 20.5 % , respectively , and the high incidence of poor quality of life was also seen in patients in PROWESS-SHOCK . Over 45 % of patients with mobility and self-care problems at 6 months in A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis died or reported persistent problems at 1 year . Conclusions : Among individuals enrolled in a clinical trial who lived independently prior to severe sepsis , one third had died and of those who survived , a further one third had not returned to independent living by 6 months . Both mortality and quality of life should be considered when design ing new interventions and considering endpoints for sepsis trials BACKGROUND Recent clinical data suggest that treatment with terlipressin ( TP ) may be more advantageous for septic shock than catecholamines . However , it is unknown whether TP would be effective for acute respiratory distress syndrome ( ARDS ) patients with shock . OBJECTIVES The aim of this study was to compare the impact of TP vs. dopamine on hemodynamic variables and vascular endothelial growth factor ( VEGF ) in ARDS patients with shock . METHODS We studied 32 ARDS patients with shock despite fluid loading , who were r and omized to receive TP ( 16 patients ) or dopamine ( 16 patients ) .  TP was administered as a continuous intravenous dose of 1.3 μg/kg/h and dopamine was administered in doses up to 20 μg/kg/min to maintain a mean arterial pressure of 70 ± 5 mm Hg for 48 h. Hemodynamic changes , ratio of partial pressure of arterial oxygen to fraction of inspired oxygen ( PaO(2)/FiO(2 ) ) , and VEGF were recorded prospect ively . RESULTS There was a significant correlation between the plasma VEGF level and the lung injury score at baseline ( r = 0.387 , p < 0.01 ) . VEGF concentrations significantly decreased from baseline levels in the TP group ( p < 0.05 ) at 48 h ; there was no difference in the dopamine group ( p > 0.05 ) at 48 h vs. baseline . There was no significant difference in the tumor necrosis factor-α concentration between the groups . CONCLUSIONS TP treatment has the potential to inhibit VEGF and improve oxygenation in patients with shock in the early stage of ARDS Introduction Recent clinical data suggest that early administration of vasopressin analogues may be advantageous compared to a last resort therapy . However , it is still unknown whether vasopressin and terlipressin are equally effective for hemodynamic support in septic shock . The aim of the present prospect i ve , r and omized , controlled pilot trial study was , therefore , to compare the impact of continuous infusions of either vasopressin or terlipressin , when given as first-line therapy in septic shock patients , on open-label norepinephrine requirements . Methods We enrolled septic shock patients ( n = 45 ) with a mean arterial pressure below 65 mmHg despite adequate volume resuscitation . Patients were r and omized to receive continuous infusions of either terlipressin ( 1.3 μg·kg-1·h-1 ) , vasopressin ( .03 U·min-1 ) or norepinephrine ( 15 μg·min-1 ; n = 15 per group ) . In all groups , open-label norepinephrine was added to achieve a mean arterial pressure between 65 and 75 mmHg , if necessary . Data from right heart and thermo-dye dilution catheterization , gastric tonometry , as well as laboratory variables of organ function were obtained at baseline , 12 , 24 , 36 and 48 hours after r and omization . Differences within and between groups were analyzed using a two-way ANOVA for repeated measurements with group and time as factors . Time-independent variables were compared with one-way ANOVA . Results There were no differences among groups in terms of systemic and regional hemodynamics . Compared with infusion of .03 U of vasopressin or 15 μg·min-1 of norepinephrine , 1.3 μg·kg-1·h-1 of terlipressin allowed a marked reduction in catecholamine requirements ( 0.8 ± 1.3 and 1.2 ± 1.4 vs. 0.2 ± 0.4 μg·kg-1·min-1 at 48 hours ; each P < 0.05 ) and was associated with less rebound hypotension ( P < 0.05 ) . At the end of the 48-hour intervention period , bilirubin concentrations were higher in the vasopressin and norepinephrine groups as compared with the terlipressin group ( 2.3 ± 2.8 and 2.8 ± 2.5 vs. 0.9 ± 0.3 mg·dL-1 ; each P < 0.05 ) . A time-dependent decrease in platelet count was only observed in the terlipressin group ( P < 0.001 48 hours vs. BL ) . Conclusions The present study provides evidence that continuous infusion of low-dose terlipressin – when given as first-line vasopressor agent in septic shock – is effective in reversing sepsis-induced arterial hypotension and in reducing norepinephrine requirements . Trial registration Clinical Trial.gov NCT00481572 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Purpose To determine the incidence of and risk factors for adverse cardiac events during catecholamine vasopressor therapy in surgical intensive care unit patients with cardiovascular failure . Methods The occurrence of any of seven predefined adverse cardiac events ( prolonged elevated heart rate , tachyarrhythmia , myocardial cell damage , acute cardiac arrest or death , pulmonary hypertension-induced right heart dysfunction , reduction of systemic blood flow ) was prospect ively recorded during catecholamine vasopressor therapy lasting at least 12 h. Results Fifty-four of 112 study patients developed a total of 114 adverse cardiac events , an incidence of 48.2 % ( 95 % CI , 38.8–57.6 % ) . New-onset tachyarrhythmia ( 49.1 % ) , prolonged elevated heart rate ( 23.7 % ) , and myocardial cell damage ( 17.5 % ) occurred most frequently . Aside from chronic liver diseases , factors independently associated with the occurrence of adverse cardiac events included need for renal replacement therapy , disease severity ( assessed by the Simplified Acute Physiology Score II ) , number of catecholamine vasopressors  ( OR , 1.73 ; 95 % CI , 1.08–2.77 ; p = 0.02 ) and duration of catecholamine vasopressor therapy ( OR , 1.01 ; 95 % CI , 1–1.01 ; p = 0.002 ) . Patients developing adverse cardiac events were on catecholamine vasopressors ( p < 0.001 ) and mechanical ventilation ( p < 0.001 ) for longer and had longer intensive care unit stays ( p < 0.001 ) and greater mortality ( 25.9 vs. 1.7 % ; p < 0.001 ) than patients who did not . Conclusions Adverse cardiac events occurred in 48.2 % of surgical intensive care unit patients with cardiovascular failure and were related to morbidity and mortality . The extent and duration of catecholamine vasopressor therapy were independently associated with and may contribute to the pathogenesis of adverse cardiac events Objectives To determine the effects of an intravenous bolus dose of a vasopressin analogue , terlipressin ( 1 mg ) , on systemic haemodynamic parameters and gastric mucosal perfusion ( GMP ) in patients with catecholamine-treated septic shock using a gastric tonometry and laser-Doppler flowmetry technique . Design Prospect i ve open label study . Setting sTwo multidisciplinary intensive care units . Patients Fifteen patients with norepinephrine-treated septic shock . Interventions Every patient with mean arterial pressure between 50 and 55 mmHg treated with high dose norepinephrine received an intravenous bolus dose of terlipressin as last resort therapy . A laser-Doppler probe and tonometer were introduced into the gastric lumen . Measurements and main results Terlipressin produced a decrease in cardiac output ( p<0.05 ) , a progressive increase in mean arterial pressure ( p<0.05 ) and in GMP , detected by laser-Doppler flowmetry ( p<0.05 ) over 30 min and sustained for at least 24 h. The ratio of GMP to systemic oxygen delivery increased after terlipressin bolus dose ( p<0.05 ) . The gradient between gastric mucosal and arterial PCO2 tended to be lower after terlipressin , and the difference was statistically significant ( p<0.05 ) after 8 h. Terlipressin administration significantly increased ( p<0.05 ) urine output compared to baseline and higher values were found at 
    Output:
    
Additionally , TP improved renal function .
The use of TP was associated with reduced mortality in septic shock patients less than 60 years old .
TP may also improve renal function and cause more peripheral ischaemia .