Norepinephrine use in cardiogenic shock patients is associated with increased 30 day mortality
Abstract Aims Norepinephrine is recommended as a first‐line vasopressor agent in the haemodynamic stabilization of cardiogenic shock. The survival benefit of norepinephrine therapy has not been demonstrated in clinical practice, however. This study aimed to explore the relationship between norepinep...
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Wiley
2022-06-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.13893 |
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| author | Xin Lu Xue Wang Yanxia Gao Joseph Harold Walline Shiyuan Yu Zengzheng Ge Mubing Qin Huadong Zhu Yi Li |
| author_facet | Xin Lu Xue Wang Yanxia Gao Joseph Harold Walline Shiyuan Yu Zengzheng Ge Mubing Qin Huadong Zhu Yi Li |
| author_sort | Xin Lu |
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| description | Abstract Aims Norepinephrine is recommended as a first‐line vasopressor agent in the haemodynamic stabilization of cardiogenic shock. The survival benefit of norepinephrine therapy has not been demonstrated in clinical practice, however. This study aimed to explore the relationship between norepinephrine use and outcomes in cardiogenic shock patients in real‐world conditions. Methods and results We conducted a retrospective cohort study based on the Medical Information Mart for Intensive Care III (MIMIC‐III) database. Cardiogenic shock patients were enrolled and categorized into a norepinephrine group or a non‐norepinephrine group. Propensity score matching (PSM) was used to control for confounders. Cox proportional‐hazards models and multivariable logistic regression were used to investigate the relationship between norepinephrine treatment and mortality. A total of 927 eligible patients were included: 552 patients in the norepinephrine group and 375 patients in the non‐norepinephrine group. After PSM, 222 cases from each group were matched using a 1:1 matching algorithm. Thirty day mortality for patients treated with norepinephrine was significantly higher than for those in the non‐norepinephrine group (41% vs. 30%, OR 1.61, 95% CI 1.09–2.39, P = 0.017; HR 1.50, 95% CI 1.09–2.06, P = 0.013). In the multivariable analysis, there was no significant difference between norepinephrine therapy and long‐term (90 day, 180 day, or 1 year) mortality (90 day (OR 1.19, 95% CI 0.82–1.74, P = 0.363), 180 day (OR 1.17, 95% CI 0.80–1.70, P = 0.418), 1 year (OR 1.14, 95% CI 0.79–1.66, P = 0.477). Patients in the norepinephrine group required more mechanical ventilation (84% vs. 67%, OR 2.67, 95% CI 1.70–4.25, P < 0.001) and experienced longer ICU stays (median 7 vs. 4 days, OR 7.92, 95% CI 1.40–44.83, P = 0.020) than non‐norepinephrine group. Conclusions Cardiogenic shock patients treated with norepinephrine were associated with significantly increased short‐term mortality, while no significant difference was found on long‐term survival rates. Future trials are needed to validate and explore this association. |
| format | Article |
| id | doaj-art-0a7df4f4263b417f86d19308110cd47b |
| institution | Kabale University |
| issn | 2055-5822 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj-art-0a7df4f4263b417f86d19308110cd47b2025-02-05T05:22:10ZengWileyESC Heart Failure2055-58222022-06-01931875188310.1002/ehf2.13893Norepinephrine use in cardiogenic shock patients is associated with increased 30 day mortalityXin Lu0Xue Wang1Yanxia Gao2Joseph Harold Walline3Shiyuan Yu4Zengzheng Ge5Mubing Qin6Huadong Zhu7Yi Li8Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College Beijing ChinaDepartment of Allergy & Clinical Immunology Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, National Clinical Research Center for Immunologic Diseases Beijing ChinaEmergency Department The First Affiliated Hospital of Zhengzhou University Zhengzhou ChinaCenter for the Humanities and Medicine The University of Hong Kong Hong Kong ChinaEmergency Department, State Key Laboratory of Complex Severe and Rare Diseases Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College Beijing ChinaEmergency Department, State Key Laboratory of Complex Severe and Rare Diseases Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College Beijing ChinaEmergency Department, State Key Laboratory of Complex Severe and Rare Diseases Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College Beijing ChinaEmergency Department, State Key Laboratory of Complex Severe and Rare Diseases Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College Beijing ChinaEmergency Department, State Key Laboratory of Complex Severe and Rare Diseases Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College Beijing ChinaAbstract Aims Norepinephrine is recommended as a first‐line vasopressor agent in the haemodynamic stabilization of cardiogenic shock. The survival benefit of norepinephrine therapy has not been demonstrated in clinical practice, however. This study aimed to explore the relationship between norepinephrine use and outcomes in cardiogenic shock patients in real‐world conditions. Methods and results We conducted a retrospective cohort study based on the Medical Information Mart for Intensive Care III (MIMIC‐III) database. Cardiogenic shock patients were enrolled and categorized into a norepinephrine group or a non‐norepinephrine group. Propensity score matching (PSM) was used to control for confounders. Cox proportional‐hazards models and multivariable logistic regression were used to investigate the relationship between norepinephrine treatment and mortality. A total of 927 eligible patients were included: 552 patients in the norepinephrine group and 375 patients in the non‐norepinephrine group. After PSM, 222 cases from each group were matched using a 1:1 matching algorithm. Thirty day mortality for patients treated with norepinephrine was significantly higher than for those in the non‐norepinephrine group (41% vs. 30%, OR 1.61, 95% CI 1.09–2.39, P = 0.017; HR 1.50, 95% CI 1.09–2.06, P = 0.013). In the multivariable analysis, there was no significant difference between norepinephrine therapy and long‐term (90 day, 180 day, or 1 year) mortality (90 day (OR 1.19, 95% CI 0.82–1.74, P = 0.363), 180 day (OR 1.17, 95% CI 0.80–1.70, P = 0.418), 1 year (OR 1.14, 95% CI 0.79–1.66, P = 0.477). Patients in the norepinephrine group required more mechanical ventilation (84% vs. 67%, OR 2.67, 95% CI 1.70–4.25, P < 0.001) and experienced longer ICU stays (median 7 vs. 4 days, OR 7.92, 95% CI 1.40–44.83, P = 0.020) than non‐norepinephrine group. Conclusions Cardiogenic shock patients treated with norepinephrine were associated with significantly increased short‐term mortality, while no significant difference was found on long‐term survival rates. Future trials are needed to validate and explore this association.https://doi.org/10.1002/ehf2.13893Cardiogenic shockNorepinephrineLarge observational databaseCohort studyPropensity score‐matching analysis |
| spellingShingle | Xin Lu Xue Wang Yanxia Gao Joseph Harold Walline Shiyuan Yu Zengzheng Ge Mubing Qin Huadong Zhu Yi Li Norepinephrine use in cardiogenic shock patients is associated with increased 30 day mortality ESC Heart Failure Cardiogenic shock Norepinephrine Large observational database Cohort study Propensity score‐matching analysis |
| title | Norepinephrine use in cardiogenic shock patients is associated with increased 30 day mortality |
| title_full | Norepinephrine use in cardiogenic shock patients is associated with increased 30 day mortality |
| title_fullStr | Norepinephrine use in cardiogenic shock patients is associated with increased 30 day mortality |
| title_full_unstemmed | Norepinephrine use in cardiogenic shock patients is associated with increased 30 day mortality |
| title_short | Norepinephrine use in cardiogenic shock patients is associated with increased 30 day mortality |
| title_sort | norepinephrine use in cardiogenic shock patients is associated with increased 30 day mortality |
| topic | Cardiogenic shock Norepinephrine Large observational database Cohort study Propensity score‐matching analysis |
| url | https://doi.org/10.1002/ehf2.13893 |
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