Clinical Efficiency of Vasopressin or Its Analogs in Comparison With Catecholamines Alone on Patients With Septic Shock: A Systematic Review and Meta-Analysis

Frontiers in Pharmacology

Guo-sheng Wu¹  Zhao-fan Xia¹  Ren-qi Yao¹  De-meng Xia²  Yi-bing Zhu³  Hong-qiang Zhao⁴  Qi Liu⁴  Yong-ming Yao⁴  Chao Ren⁴  Li-xue Wang⁴ 

[1] Department of Burn Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China;Department of Emergency, Changhai Hospital, The Second Military Medical University, Shanghai, China;Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Beijing, China;Trauma Research Center, Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China;

关键词: vasopressin;    terlipressin;    selepressin;    norepinephrine;    septic shock;   

DOI  :  10.3389/fphar.2020.00563

来源: DOAJ

【 摘 要 】

BackgroundVasopressin is an efficient remedy for septic shock patients as its great capacity in promoting hemodynamic stabilization. The aim of current systematic review and meta-analysis is to compare the clinical efficiency of vasopressin or its analogs with sole catecholamines on patients with septic shock.MethodsA systematic search of Cochrane Library, EMBASE, and PubMed online databases was performed up to 30 Oct 2019 to identify randomized controlled trials comparing use of vasopressin or its analogs (e.g., terlipressin, selepressin) with administration of catecholamines alone.ResultsWe included 23 RCTs with 4,225 patients in the current study. Compared with solely use of catecholamines, administration of vasopressin or its analogs was not associated with reduced 28-day or 30-day mortality among patients with septic shock [RR=0.94 (95% CI, 0.87–1.01), P=0.08, I2 = 0%]. The result of primary endpoint remained unchanged after conducting sensitivity analysis. Despite a significantly higher risk of digital ischemia in patients receiving vasopressin or its analogs [RR=2.65 (95% CI, 1.26–5.56), P < 0.01, I2 = 48%], there was no statistical significance in the pooled estimate for other secondary outcomes, including total adverse events, arrhythmia, acute myocardial infarction (AMI) and cardiac arrest, acute mesenteric ischemia, ICU/hospital length of stay, and mechanical ventilation (MV) duration.ConclusionsThe administration of vasopressin or its analogs was not associated with reduced 28-day or 30-day mortality among patients with septic shock, while an increased incidence of digital ischemia should be noted in patients receiving agonists for vasopressin receptors.

【 授权许可】

Unknown