The effect of dobutamine in sepsis: a propensity score matched analysis.
Dobutamine
Hospital mortality
Propensity score matched analysis
Sepsis
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
11 Nov 2021
11 Nov 2021
Historique:
received:
04
11
2020
accepted:
09
11
2021
entrez:
11
11
2021
pubmed:
12
11
2021
medline:
16
11
2021
Statut:
epublish
Résumé
The use of dobutamine in patients with sepsis is questionable currently. As the benefit of dobutamine in septic patients is unclear, we aimed to evaluate whether the use of dobutamine was associated with decreased hospital mortality in sepsis patients. Based on the analysis of MIMIC III public database, we performed a big-data, real world study. According to the use of dobutamine or not, patients were categorized as the dobutamine group or non dobutamine group.We used propensity score matched (PSM) analysis to adjust for confoundings. The primary outcome was hospital mortality. In the present study, after screening 38,605 patients, 2826 patients with sepsis were included. 121 patients were in dobutamine group and 2165 patients were in non dobutamine group. Compared with patients in non-dobutamine group, patients in dobutamine group had a lower MAP, higher HR, higher RR, higher severity of illness scores. 72 of 121 patients (59.5%) in the dobutamine group and 754 of 2165 patients (34.8%) in the non-dobutamine group died in the hospital, which resulted in a significant between-group difference (OR 1.56, 95% CI 1.01-2.40; P = 0.000). For the secondary outcomes, patients in dobutamine group received more MV use, more renal replacement therapy use, had longer ICU stay durations and more cardiac arrhythmias than those in non-dobutamine group. After adjusting for confoundings between groups by PSM analysis, hospital mortality was consistently higher in dobutamine group than that in non-dobutamine group (60.2% vs. 49.4%, OR 1.55, 95% CI 1.01-2.37; P = 0.044). Among patients with sepsis, our study showed that the use of dobutamine was not associated with decreased hospital mortality. Further large scale, randomized controlled studies are warrented to confirm our findings.
Sections du résumé
BACKGROUND
BACKGROUND
The use of dobutamine in patients with sepsis is questionable currently. As the benefit of dobutamine in septic patients is unclear, we aimed to evaluate whether the use of dobutamine was associated with decreased hospital mortality in sepsis patients.
METHODS
METHODS
Based on the analysis of MIMIC III public database, we performed a big-data, real world study. According to the use of dobutamine or not, patients were categorized as the dobutamine group or non dobutamine group.We used propensity score matched (PSM) analysis to adjust for confoundings. The primary outcome was hospital mortality.
RESULTS
RESULTS
In the present study, after screening 38,605 patients, 2826 patients with sepsis were included. 121 patients were in dobutamine group and 2165 patients were in non dobutamine group. Compared with patients in non-dobutamine group, patients in dobutamine group had a lower MAP, higher HR, higher RR, higher severity of illness scores. 72 of 121 patients (59.5%) in the dobutamine group and 754 of 2165 patients (34.8%) in the non-dobutamine group died in the hospital, which resulted in a significant between-group difference (OR 1.56, 95% CI 1.01-2.40; P = 0.000). For the secondary outcomes, patients in dobutamine group received more MV use, more renal replacement therapy use, had longer ICU stay durations and more cardiac arrhythmias than those in non-dobutamine group. After adjusting for confoundings between groups by PSM analysis, hospital mortality was consistently higher in dobutamine group than that in non-dobutamine group (60.2% vs. 49.4%, OR 1.55, 95% CI 1.01-2.37; P = 0.044).
CONCLUSIONS
CONCLUSIONS
Among patients with sepsis, our study showed that the use of dobutamine was not associated with decreased hospital mortality. Further large scale, randomized controlled studies are warrented to confirm our findings.
Identifiants
pubmed: 34758739
doi: 10.1186/s12879-021-06852-8
pii: 10.1186/s12879-021-06852-8
pmc: PMC8582172
doi:
Substances chimiques
Dobutamine
3S12J47372
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1151Subventions
Organisme : Guangzhou Science, Technology and Innovation Commission
ID : 201904010258
Informations de copyright
© 2021. The Author(s).
Références
Crit Care Med. 2007 May;35(5):1244-50
pubmed: 17414736
Rev Cardiovasc Med. 2004 Spring;5(2):130-3
pubmed: 15188772
JAMA. 2016 Feb 23;315(8):801-10
pubmed: 26903338
Medicine (Baltimore). 2016 Sep;95(39):e5031
pubmed: 27684877
J Intensive Care. 2017 Nov 21;5:65
pubmed: 29201378
Lancet. 2007 Aug 25;370(9588):636-7
pubmed: 17719998
Med Intensiva (Engl Ed). 2018 Jun - Jul;42(5):283-291
pubmed: 29100618
Intensive Care Med. 2013 Feb;39(2):165-228
pubmed: 23361625
Inflammation. 2012 Feb;35(1):206-13
pubmed: 21347606
N Engl J Med. 2003 Apr 17;348(16):1546-54
pubmed: 12700374
Ann Intensive Care. 2019 Feb 4;9(1):26
pubmed: 30715638
N Engl J Med. 1994 Jun 16;330(24):1717-22
pubmed: 7993413
Am J Physiol Heart Circ Physiol. 2017 Jun 1;312(6):H1224-H1237
pubmed: 28455289
J Am Med Inform Assoc. 2018 Jan 1;25(1):32-39
pubmed: 29036464
N Engl J Med. 2014 May 1;370(18):1683-93
pubmed: 24635773
J Am Coll Cardiol. 2005 Jul 5;46(1):57-64
pubmed: 15992636
N Engl J Med. 2015 Apr 2;372(14):1301-11
pubmed: 25776532
Anatol J Cardiol. 2018 Aug;20(2):134
pubmed: 30088490
Med Care. 2009 Jun;47(6):626-33
pubmed: 19433995
Circulation. 2000 Jun 13;101(23):E215-20
pubmed: 10851218
N Engl J Med. 1995 Oct 19;333(16):1025-32
pubmed: 7675044
PLoS Med. 2007 Oct 16;4(10):e296
pubmed: 17941714
Acta Anaesthesiol Scand. 2013 Apr;57(4):431-42
pubmed: 23298252
Crit Care. 2011 Jul 07;15(4):R162
pubmed: 21736726
Aust Crit Care. 2019 Mar;32(2):155-164
pubmed: 29574007
N Engl J Med. 2014 Oct 16;371(16):1496-506
pubmed: 25272316
Circulation. 2012 Mar 27;125(12):1511-9
pubmed: 22368152
Am Heart J. 2007 Jan;153(1):98-104
pubmed: 17174645
N Engl J Med. 2016 Oct 5;375(17):1638-1648
pubmed: 27705084
Med Care. 2005 Nov;43(11):1130-9
pubmed: 16224307
Anatol J Cardiol. 2018 Jun;19(6):412-416
pubmed: 29848925
Am J Infect Control. 2018 Sep;46(9):1041-1046
pubmed: 29609853
Sci Data. 2016 May 24;3:160035
pubmed: 27219127
Intensive Care Med. 2017 Mar;43(3):304-377
pubmed: 28101605
Crit Care Med. 2006 Sep;34(9):2392-8
pubmed: 16849997
Crit Care. 2008;12(2):R35
pubmed: 18318900