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Association between inotrope treatment and 90‐day mortality in patients with septic shock
Author(s) -
WILKMAN E.,
KAUKONEN K.M.,
PETTILÄ V.,
KUITUNEN A.,
VARPULA M.
Publication year - 2013
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12056
Subject(s) - inotrope , medicine , septic shock , dobutamine , propensity score matching , anesthesia , pulmonary artery catheter , intensive care unit , blood pressure , sepsis , cardiology , hemodynamics , cardiac output
Background Administration of inotropes in septic patients with low cardiac output or low central/mixed venous saturation is recommended in current guidelines. However, the impact of inotrope use on the outcome of these patients is controversial. We aimed to analyse the association of inotrope treatment with 90‐day mortality. Methods Data from 420 consecutive patients with septic shock were retrospectively collected from the intensive care unit ( ICU ) data management system. Factors associated with inotrope treatment were assessed. The association of 90‐day mortality with inotrope treatment was first analysed using logistic regression analysis, and second including propensity score based on observed variables for selection to inotrope treatment. A subgroup analysis was performed for the 252 patients with pulmonary artery catheter. Results One hundred eighty‐six (44.3%) patients received inotrope treatment during the first 24 h in ICU . Of those, 168 (90.3%) received dobutamine, 29 (15.6%) levosimendan, and 23 (12.4%) epinephrine. Blood lactate ( P < 0.001), central venous pressure, ( P < 0.001), and norepinephrine dose ( P = 0.03) were independently associated with inotrope treatment. Patients with inotrope treatment had a higher 90‐day mortality (42.5% vs. 23.9%, P < 0.001). Age ( P < 0.001), Acute Physiology and Chronic Health Evaluation II score ( P < 0.001), and inotrope treatment ( P = 0.003) were independently associated with 90‐day mortality also after adjustment with propensity score. Conclusion The use of inotrope treatment in septic shock was associated with increased 90‐day mortality without and after adjustment with propensity to receive inotrope. To differentiate between non‐observed biases of severity of septic shock and an unfavourable effect of inotropes, prospective studies are needed.