Abstract
BackgroundThe 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.MethodsBased 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.ResultsIn 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).ConclusionsAmong 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.
Highlights
The use of dobutamine in patients with sepsis is questionable currently
Primary outcome and propensity score matched (PSM) analysis For the primary outcome of hospital mortality, 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 betweengroup difference (Table 2)
SOFA Sequential Organ Failure Assessment, ranging from 0 to 24, with higher scores indicating a greater degree of organ failure; ECI Elixhauser comorbidity index, and we used the modified vanWalraven Elixhauser comorbidity score in our study, which consists of 30 comorbidity diseases, range from − 19 to 89 points, with higher scores indicating a greater risk of hospital mortality, MAP mean arterial pressure; HR: heart rate, RR respiratory rate, Simplified acute physiologic score-I (SAPS-I) simplified acute physiologic score-I, Simplified Acute Physiology Score-II (SAPS-II) simplified acute physiologic score-II, Intensive care unit (ICU) intensive care unit, Chronic obstructive pulmonary disease (COPD) chronic obstructive pulmonary disease
Summary
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. No randomized controlled trials have performed to evaluate whether there are significant differences between dobutamine and placebo on clinical outcomes in septic patients. The adverse effects with the use of dobutamine were not detected in the previous studies. The use of dobutamine in patients with sepsis is questionable currently. As the benefit of dobutamine in septic patients is unclear so far, in this study, we aimed to evaluate whether the use of dobutamine was associated with decreased hospital mortality in sepsis patients
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