Yub Raj Sedhai, MD
MD
Virginia Commonwealth University, United States
Disclosure information not submitted.
Dhan Shrestha, MD
Resident Physician
Mount Sinai Hospital
Chicago, Illinois, United States
Disclosure information not submitted.
Pravash Budhathoki, MD
Resident Physician
BronxCare Health System, Bronx, NY, USA
Bronx, New York, United States
Disclosure information not submitted.
Waqas Memon, MD
Nephrologist
VCU School of Medicine, Richmond, VA, Virginia, United States
Disclosure information not submitted.
Roshan Acharya, MD
Medical doctor
Cape Fear Valley Medical Center; 1638 Owen Dr; Fayetteville,NC 28304, North Carolina, United States
Disclosure information not submitted.
Ankush Asija, MD
Hospitalist
West Virginia University, Morgantown, WV 26506, Virginia, United States
Disclosure information not submitted.
Suman Gaire, MBBS
Medical doctor
Palpa Hospital, Palpa, Nepal
Palpa, Lumbini, Nepal
Disclosure information not submitted.
Nisheem Pokharel, MBBS
Medical doctor
KIST Medical College, Lalitpur, Nepal, Bagmati, Nepal
Disclosure information not submitted.
Swojay Maharjan, MBBS
Medical student
Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
Kathmandu, Bagmati, Nepal
Disclosure information not submitted.
Ranjit Jasaraj, MD
Resident Physician
Mount Sinai Hospital
Chicago, Illinois, United States
Disclosure information not submitted.
Dipen Kadaria, MD
Medical doctor
The University of Tennessee Health Science Center, Tennessee, United States
Disclosure information not submitted.
Markos G. Kashiouris, MD, MPH
Medical doctor
Virginia Commonwealth University, School of Medicine, Richmond; USA, Virginia, United States
Disclosure information not submitted.
Title: Vasopressin Vs. Norepinephrine as the First-line Vasopressor in Septic Shock; Meta-Analysis
Introduction: Although norepinephrine is the first-line vasopressor for the management of septic shock, some studies have shown definite clinical benefits with vasopressin as initial therapy. We conducted this systematic review and meta-analysis to compare vasopressin versus norepinephrine in septic shock.
Methods: Using appropriate keywords, we searched PubMed, PubMed Central, Embase, and Scopus databases. We included randomized clinical trials and prospective or retrospective observational studies that compared the effects of vasopressin with norepinephrine in adult patients with septic shock. We analyzed the extracted data using Revman 5.4. According to heterogeneity, continuous data were evaluated by mean difference, and discrete data were evaluated using the odds ratio by using the fixed/random effects model. I2 test was used to measure the statistical heterogeneity of the studies.
Results: We included eight studies including five RCTs in our meta-analysis among 2442 studies screened.We did not find any significant differences in 28 days mortality (OR, 1.07; CI, 0.80-1.44; I2 = 51%) and ICU mortality (OR, 0.74; CI, 0.21-2.67; I2 = 0%) between the groups. Similarly, the patients in both vasopressin and norepinephrine group had similar length of ICU stay (MD, -0.24; CI, -1.35 to 0.86; I2 = 41%) and length of hospital stay (MD, -0.49; CI, -3.12 to 2.14; I2 = 0%). Both groups attained comparable MAP at 24 hours (MD, -0.88; CI, -2.47 to 0.72; I2 = 3%) and 48 hours (MD, -0.18; CI, -2.26 to 1.91; I2 = 0%) after initiation of treatment. However, the patients in the vasopressin group had lower odds of the requirement of Kidney replacement therapy as compared to the norepinephrine group(OR, 0.68; CI, 0.47-0.98; I2 = 0%). But, there was no statistical difference in urine output in patients in both groups at 24 hours and 48 hours, and odds of serious adverse events.
Conclusion: For adults with septic shock, vasopressin attains similar MAP as norepinephrine and reaches similar outcomes in terms of mortality, hospital stay, urine output, and serious adverse effects. However, vasopressin may be superior to norepinephrine in the requirement of kidney replacement therapy in patients with septic shock. Further large-scale clinical trials are necessary to explore the clinical benefits of vasopressin in septic shock.