TY - JOUR
T1 - Epinephrine and short-term survival in cardiogenic shock: an individual data meta-analysis of 2583 patients
AU - Léopold, Valentine
AU - Gayat, Etienne
AU - Pirracchio, Romain
AU - Spinar, Jindrich
AU - Parenica, Jiri
AU - Tarvasmäki, Tuukka
AU - Lassus, Johan
AU - Harjola, Veli-Pekka
AU - Champion, S. bastien
AU - Zannad, Faiez
AU - Valente, Serafina
AU - Urban, Philip
AU - Chua, Horng-Ruey
AU - Bellomo, Rinaldo
AU - Popovic, Batric
AU - Ouweneel, Dagmar M.
AU - Henriques, José P. S.
AU - Simonis, Gregor
AU - Lévy, Bruno
AU - Kimmoun, Antoine
AU - Gaudard, Philippe
AU - Basir, Mir Babar
AU - Markota, Andrej
AU - Adler, Christoph
AU - Reuter, Hannes
AU - Mebazaa, Alexandre
AU - Chouihed, Tahar
PY - 2018
Y1 - 2018
N2 - Objective: Catecholamines have been the mainstay of pharmacological treatment of cardiogenic shock (CS). Recently, use of epinephrine has been associated with detrimental outcomes. In the present study we aimed to evaluate the association between epinephrine use and short-term mortality in all-cause CS patients. Design: We performed a meta-analysis of individual data with prespecified inclusion criteria: (1) patients in non-surgical CS treated with inotropes and/or vasopressors and (2) at least 15% of patients treated with epinephrine administrated alone or in association with other inotropes/vasopressors. The primary outcome was short-term mortality. Measurements and results: Fourteen published cohorts and two unpublished data sets were included. We studied 2583 patients. Across all cohorts of patients, the incidence of epinephrine use was 37% (17–76%) and short-term mortality rate was 49% (21–69%). A positive correlation was found between percentages of epinephrine use and short-term mortality in the CS cohort. The risk of death was higher in epinephrine-treated CS patients (OR [CI] = 3.3 [2.8–3.9]) compared to patients treated with other drug regimens. Adjusted mortality risk remained striking in epinephrine-treated patients (n = 1227) (adjusted OR = 4.7 [3.4–6.4]). After propensity score matching, two sets of 338 matched patients were identified and epinephrine use remained associated with a strong detrimental impact on short-term mortality (OR = 4.2 [3.0–6.0]). Conclusions: In this very large cohort, epinephrine use for hemodynamic management of CS patients is associated with a threefold increase of risk of death.
AB - Objective: Catecholamines have been the mainstay of pharmacological treatment of cardiogenic shock (CS). Recently, use of epinephrine has been associated with detrimental outcomes. In the present study we aimed to evaluate the association between epinephrine use and short-term mortality in all-cause CS patients. Design: We performed a meta-analysis of individual data with prespecified inclusion criteria: (1) patients in non-surgical CS treated with inotropes and/or vasopressors and (2) at least 15% of patients treated with epinephrine administrated alone or in association with other inotropes/vasopressors. The primary outcome was short-term mortality. Measurements and results: Fourteen published cohorts and two unpublished data sets were included. We studied 2583 patients. Across all cohorts of patients, the incidence of epinephrine use was 37% (17–76%) and short-term mortality rate was 49% (21–69%). A positive correlation was found between percentages of epinephrine use and short-term mortality in the CS cohort. The risk of death was higher in epinephrine-treated CS patients (OR [CI] = 3.3 [2.8–3.9]) compared to patients treated with other drug regimens. Adjusted mortality risk remained striking in epinephrine-treated patients (n = 1227) (adjusted OR = 4.7 [3.4–6.4]). After propensity score matching, two sets of 338 matched patients were identified and epinephrine use remained associated with a strong detrimental impact on short-term mortality (OR = 4.2 [3.0–6.0]). Conclusions: In this very large cohort, epinephrine use for hemodynamic management of CS patients is associated with a threefold increase of risk of death.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85047904126&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29858926
U2 - https://doi.org/10.1007/s00134-018-5222-9
DO - https://doi.org/10.1007/s00134-018-5222-9
M3 - Review article
C2 - 29858926
SN - 0342-4642
VL - 44
SP - 847
EP - 856
JO - Intensive care medicine
JF - Intensive care medicine
IS - 6
ER -