(958) Evaluation of Octreotide Dosing for High-Output States: A Single-Center, Retrospective Experience

Introduction: High output volume from abdominal fistulas, small bowel ostomies, and abdominal drains is an uncommon but serious complication of abdominal surgery and trauma. Octreotide is utilized to slow bowel transit, increase intraluminal viscosity, and decrease output. This study aimed to evaluate treatment response to high versus low doses of octreotide in patients with high output states.

Methods: This single center, retrospective cohort study included adults who received ≥48 hours of octreotide for high output states, which included abdominal fistulas, small bowel ostomies, or intraabdominal drains with ≥500 mL of recorded output per 24-hour period. Patients were divided into two cohorts based on octreotide dosage: high dose (≥600 mcg/day) and low dose ( < 600 mcg/day). The primary outcome was the treatment response defined as ≥20% reduction in 24-hour output within 7 days of octreotide initiation. Secondary outcomes included enteral feed tolerance, incidence of electrolyte abnormalities, and time to treatment response.

Results: A total of 58 patients (n=32 low dose (LD), n=26 high dose (HD)) were included. Demographics were similar between groups. The median octreotide total daily dose was 300 mcg (244-450) in the LD versus 670.8 mcg (667-750) in HD cohort. Baseline output was higher in the LD group compared to the HD group (LD 1762.3mL [1234-2794] vs. HD 1277.5mL [1037-2082]; p=0.09). Treatment response did not differ significantly between LD and HD cohorts (LD 68.7% vs HD 73.1%; p=0.78). Kaplan-Meier curve demonstrated similar median time to treatment response (HD 2 [1.2-2.8] vs LD 2 [1.3-2.7], p=0.66) with all response events occurring within 4 days [ ] of therapy initiation. The HD cohort was associated with less electrolyte abnormalities (9.9% vs. 14.2%, p=0.04). There were no observed significant statistical or clinical differences among secondary endpoints. No predictive factors for treatment response were identified.

Conclusions: Among patients receiving octreotide for high output states, no difference in treatment response was observed when comparing HD vs LD. Time to response data suggests that response to octreotide therapy should be observed within 4 days of therapy. Larger studies are necessary to assess the role of octreotide and optimal dosing for high output states.