Abstract
Abstract Background To investigate the clinical effects of norepinephrine versus dopamine in treatment of septic shock by pooling the data form open published clinical trials. Material and Methods The clinical trials relevant to norepinephrine versus dopamine in treatment of septic shock were electronically searched in the databases of Pubmed, Embase, the Cochrane Library, Web of Science, Google scholar and CNKI. The original data related to the treatment effects such as death risk, oxygen metabolism and hemodynamics index were extracted from the included original studies. The death risk was pooled by the effect size of relative risk (RR), the oxygen metabolism and hemodynamics index were pooled by standard mean difference (SMD) and the corresponding 95% confidence interval (95%CI). The publication bias was evaluated by Begg's funnel plot and Egger's line regression test. Results Thirteen clinical trials were included in the meta-analysis. The pooled results demonstrated the death risk was significantly decreased (RR=0.89, 95%CI:0.81 to 0.98, p=0.024) in septic shock patients who received norepinephrine compared to those receiving dopamine. The HR (SMD=−1.84, 95%CI: −2.86 to −0.81, p<0.01) and cardiac index (SMD=−0.74, 95%CI: −1.01 to −0.48, p<0.01) were lower in norepinephrine group compared to dopamine group. The systemic vascular resistance index (SMD=1.33, 95%CI:0.62 to 2.04, p<0.01) in norepinephrine group was higher than those of dopamine group with statistical difference. The Begg's funnel plot and Egger's line regression test (t=−0.84, p=0.425) showed no publication bias. Conclusions Based on the present evidence, norepinephrine was superior to dopamine in the aspects of death risk reducing and hemodynamics.
Highlights
Sepsis refers to the organ dysfunction, which is lifethreatening due to the maladjustment of host response caused by infection [1]
The pooled results demonstrated the death risk was significantly decreased (RR=0.89, 95% confidence interval (95%CI):0.81 to 0.98, p=0.024) in septic shock patients who received norepinephrine compared to those receiving dopamine
The HR (SMD=-1.84, 95%CI:-2.86 to -0.81, p
Summary
Sepsis refers to the organ dysfunction, which is lifethreatening due to the maladjustment of host response caused by infection [1]. Septic shock is a form of sepsis which is seriously and life threatening. Diagnosis and treatment of life threatening septic shock are extremely important for improving the patients’ prognosis and survival [2]. The mortality of septic shock was still high despite the applecation of intensive treatment, including vasoactive drugs, volume resuscitation, effective anti-infection, mechanical ventilation etc. Norepinephrine and dopamine have been used as the first-line drugs in the treatment of septic shock, but their clinical efficacy were controversial according to the results of previous publications. In year 2012, a meta-analysis relevant to norepinephrine versus dopamine in treatment of septic shock indicated that the death risk was significant decreased in patients received norepinephrine compared to dopamine [4]. To investigate the clinical effects of norepinephrine versus dopamine in treatment of septic shock by pooling the data form open published clinical trials
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