Darien Davda, MD
Hospitalist
Prisma Health Upstate
Greenville, SC
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Title: Midodrine Beyond the Hospital: A Retrospective Cohort Study
Introduction: In recent years, using midodrine to wean patients off vasopressors has become of interest to decrease time in the ICU. To date, sparse research exists regarding outcomes of patients discharged from the hospital on midodrine. This retrospective cohort study examined long term outcomes of patients who received midodrine on discharge vs patients who did not receive midodrine on discharge after being managed for septic shock.
Methods: Charts from 2016 to 2020 were reviewed for patients admitted to the ICU for septic shock and initiated on vasopressors. Those who were initiated and discharged home on midodrine were stratified to one group, and those not given midodrine were stratified to another. Over the course of one year, these patients were tracked for mortality, hospital readmission, and adverse cardiac events. Additional data such as number of days on vasopressors, blood pressures on discharge and follow up, and renal function were recorded. Statistical analysis was done with Chi-Square tests and independent t-tests.
Results: Regarding 1-year mortality, being discharged home with midodrine was associated with an increased risk of death (RR=1.83) that was not statistically significant (X2 (2, N=60) = 2.05, p=.15), whereas readmission within 1-year was associated with a statistically significant increased risk (X2(2, N=60) =5.45, p=.02). There was no significant difference between groups regarding time on vasopressors (t (60) =1.57, p=.06). Neither group had significant differences in renal failure or adverse cardiac events.
Conclusion: Patients discharged from the ICU with continued midodrine appear to have a higher likelihood for adverse events in contrast to those not initiated. Future research should focus additionally on outcomes of patients discharged with midodrine as well as in the ICU. At best, a soft recommendation could be considered to wean patients off midodrine prior to discharge if possible.