Effect of norepinephrine dosage on mortality in patients with septic shock.
Effect of norepinephrine dosage on mortality in patients with septic shock.
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DOI：
10.1186/s40560-018-0280-1
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发表时间：
2018
影响因子：
7.1
通讯作者：
Morimoto T
中科院分区：
文献类型：
--
作者：
Yamamura H;Kawazoe Y;Miyamoto K;Yamamoto T;Ohta Y;Morimoto T
使用高剂量去甲肾上腺素被认为具有免疫抑制作用，可增加死亡率。本研究旨在评价去甲肾上腺素剂量与感染性休克患者预后的相关性。本研究是一项在重症监护室随机评价（DESMERE）试验中使用右旋美托咪定治疗脓毒症的嵌套队列。我们评估了112例感染性休克患者，初始序贯器官衰竭评估心血管（SOFA-C）类别评分> 2，初始乳酸水平> 2 mmol/L。我们根据患者在最初7天内使用的去甲肾上腺素剂量将患者分为两组：高剂量（≥ 416 μg/kg/周）（H组，n = 56）和低剂量（< 416 μg/kg/周）（L组，n = 56）。关注的主要结局是28天死亡率。次要结局是无呼吸机天数、初始24小时输注量、初始24- 48小时输注量和肾脏替代治疗的需要。对于H组和L组之间的比较，我们对分类变量使用卡方检验或Fisher精确检验，对连续变量使用t检验或Wilcoxon秩和检验。对于至事件发生时间结局，使用了考克斯比例风险模型。建立Kaplan-Meier生存曲线用于图示。除SOFA-C评分和纤维蛋白原降解产物水平外，两组患者特征相似。L组和H组第28天时的死亡累积发生率分别为29.9%（16例患者）和29.7%（15例患者）（p = 0.99）。L组28天无呼吸机天数的中位数为20（0，25），H组为16（0，22）（p < 0.05）。H组0-24 h的初始输注量显著高于L组（p = 0.004）。H组24-48 h的输注量也显著高于L组（p = 0.03）。与低剂量去甲肾上腺素治疗的感染性休克患者相比，高剂量去甲肾上腺素治疗的感染性休克患者28天死亡率无统计学显著差异。但L组无呼吸机天数高于H组。clinicaltrials.gov标识符：NCT 01760967试验注册日期：2013年1月4日。
Use of high-dose norepinephrine is thought to have an immunosuppressive action that increases mortality. This study aimed to evaluate the correlation between norepinephrine dosage and prognosis of patients with septic shock. This study was a nested cohort of the DExmedetomidine for Sepsis in Intensive Care Unit Randomized Evaluation (DESIRE) trial. We evaluated 112 patients with septic shock and an initial Sequential Organ Failure Assessment Cardiovascular (SOFA-C) category score > 2 and initial lactate level > 2 mmol/L. We divided the patients into two groups according to the norepinephrine dosage administered over the initial 7 days: high dose (≥ 416 μg/kg/week) (H group, n = 56) and low dose (< 416 μg/kg/week) (L group, n = 56). The primary outcome of interest was 28-day mortality. Secondary outcomes were ventilator-free days, initial 24-h infusion volume, initial 24- to 48-h infusion volume, and the need for renal replacement therapy. For comparisons between the H group and L group, we used the chi-square test or Fisher’s exact test for categorical variables and the t test or Wilcoxon rank sum test for continuous variables. For time-to-event outcomes, Cox proportional hazards models were used. Kaplan-Meier survival curves were created for graphical representation. Patient characteristics appeared to be similar between the two groups except for the SOFA-C score and fibrinogen degradation product level. The cumulative incidence of death at 28 days was 29.9% (16 patients) in the L group and 29.7% (15 patients) in the H group (p = 0.99). The median number of 28-day ventilator-free days was 20 (0, 25) in the L group and 16 (0, 22) in the H group (p < 0.05). Initial infusion volume at 0–24 h in the H group was significantly higher than that in the L group (p = 0.004). Infusion volume at 24–48 h in the H group was also significantly higher than that in the L group (p = 0.03). No statistically significant difference was observed in 28-day mortality between patients with septic shock treated with high-dose norepinephrine compared with those treated with low-dose norepinephrine. However, the number of ventilator-free days in the L group was higher than that in the H group. clinicaltrials.gov Identifier: NCT01760967 Date of trial registration: January 4, 2013.
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影响因子：
120.7
作者：
Boomer, Jonathan S.;To, Kathleen;Chang, Kathy C.;Takasu, Osamu;Osborne, Dale F.;Walton, Andrew H.;Bricker, Traci L.;Jarman, Stephen D., II;Kreisel, Daniel;Krupnick, Alexander S.;Srivastava, Anil;Swanson, Paul E.;Green, Jonathan M.;Hotchkiss, Richard S.
通讯作者：
Hotchkiss, Richard S.
影响因子：
120.7
作者：
Morelli, Andrea;Ertmer, Christian;Singer, Mervyn
通讯作者：
Singer, Mervyn
影响因子：
38.9
作者：
Rhodes, Andrew;Evans, Laura E.;Dellinger, R. Phillip
通讯作者：
Dellinger, R. Phillip
DOI：
10.1097/ta.0b013e318031afd3
发表时间：
2007-03-01
影响因子：
--
作者：
Jeschke, Marc G.;Norbury, William B.;Herndon, David N.
通讯作者：
Herndon, David N.
影响因子：
8.8
作者：
Povoa, Pedro R.;Carneiro, Antonio H.;Pereira, Altamiro C.
通讯作者：
Pereira, Altamiro C.