Early administration of multiple vasopressors is associated with better survival in patients with sepsis: a propensity score-weighted study

作者：Tong, Xin; Xue, Xiaopeng; Duan, Chuanzhi; Liu, Aihua^*

来源：EUROPEAN JOURNAL OF MEDICAL RESEARCH, 2023, 28(1): 249.

DOI：10.1186/s40001-023-01229-w

• Sepsis
• Vasopressor
• Multiple agents
• Mortality
• Early treatment

Background The association between the timing of administration of multiple vasopressors and patient outcomes has not been investigated. @@@ Methods This study used data from the MIMIC-IV database. Patients with sepsis who were administered two or more vasopressors were included. The principal exposure was the last norepinephrine dose when adding a second vasopressor. The cohort was divided into early (last norepinephrine dose < 0.25 mu g/kg/min) and normal (last norepinephrine dose >= 0.25 mu g/kg/min) groups. The primary outcome was 28-day mortality. Multivariable Cox analyses, propensity score matching, stabilized inverse probability of treatment weighting (sIPTW), and restricted cubic spline (RCS) curves were used. @@@ Results Overall, 1,437 patients who received multiple vasopressors were included. Patients in the early group had lower 28- day mortality (HR: 0.76; 95% CI: 0.65-0.89; p < 0.001) than those in the single group, with similar results in the propensity score-matched (HR: 0.80; 95% CI: 0.68-0.94; p = 0.006) and sIPTW (HR: 0.75; 95% CI: 0.63-0.88; p < 0.001) cohorts. RCS curves showed that the risk of 28-day mortality increased as the last norepinephrine dose increased. @@@ Conclusions The timing of secondary vasopressor administration is strongly associated with the outcomes of patients with sepsis.

• 单位
  南方医科大学