Abstract
The effect of early vasopressin initiation on clinical outcomes in patients with septic shock is uncertain. A systematic review and meta-analysis was performed to evaluate the impact of early start of vasopressin support within 6 h after the diagnosis on clinical outcomes in septic shock patients. We searched the PubMed, Cochrane, and Embase databases for randomized controlled trials (RCTs) and cohort studies from inception to the 1st of February 2021. We included studies involving adult patients (> 16 years)with septic shock. All authors reported our primary outcome of short-term mortality and in the experimental group patients in the studies receiving vasopressin infusion within 6 h after diagnosis of septic shock and in the control group patients in the studies receiving no vasopressin infusion or vasopressin infusion 6 h after diagnosis of septic shock, clearly comparing with clinically relevant secondary outcomes(use of renal replacement therapy(RRT),new onset arrhythmias, ICU length of stay and length of hospitalization). Results were expressed as odds ratio (OR) and mean difference (MD) with accompanying 95% confidence interval (CI). Five studies including 788 patients were included. The primary outcome of this meta-analysis showed that short-term mortality between the two groups was no difference (odds ratio [OR] = 1.09; 95% CI, 0.8 to 1.48; P = 0.6; χ2 = 0.83; I2 = 0%). Secondary outcomes demonstrated that the use of RRT was less in the experimental group than that of the control group (OR = 0.63; 95% CI, 0.44 to 0.88; P = 0.007; χ2 = 3.15; I2 = 36%).The new onset arrhythmias between the two groups was no statistically significant difference (OR = 0.59; 95% CI, 0.31 to 1.1; P = 0.10; χ2 = 4.7; I2 = 36%). There was no statistically significant difference in the ICU length of stay(mean difference = 0.16; 95% CI, - 0.91 to 1.22; P = 0.77; χ2 = 6.08; I2 = 34%) and length of hospitalization (mean difference = -2.41; 95% CI, -6.61 to 1.78; P = 0.26; χ2 = 8.57; I2 = 53%) between the two groups. Early initiation of vasopressin in patients within 6 h of septic shock onset was not associated with decreased short-term mortality, new onset arrhythmias, shorter ICU length of stay and length of hospitalization, but can reduce the use of RRT. Further large-scale RCTs are still needed to evaluate the benefit of starting vasopressin in the early phase of septic shock.
Highlights
Septic shock, which is characterized by severe hemodynamic failure, remains a major challenge associated with 30% to 40% hospital mortality, even though important therapeutic advances have been made over the past decades[1]
Early initiation of vasopressin in patients within 6 hours of septic shock onset was not associated with decreased short-term mortality, new onset arrhythmias, shorter ICU length of stay and length of hospitalization, but can reduce the use of renal replacement therapy (RRT)
Further large-scale randomized controlled trials (RCTs) are still needed to evaluate the benefit of starting vasopressin in the early phase of septic shock
Summary
Septic shock, which is characterized by severe hemodynamic failure, remains a major challenge associated with 30% to 40% hospital mortality, even though important therapeutic advances have been made over the past decades[1]. Vasopressin was not initiated until almost 12 hours after study criteria were met, which may have adversely affected its potential impact on patient outcomes. Pilot studies have more recently evaluated earlier initiation of vasopressin with or not with norepinephrine, and observed encouraging findings[4,5,6], including improvements of renal function[5] and sequential organ failure assessment (SOFA) scores[6] at 48 and 72 hours after admission and fewer episodes of new-onset arrhythmias[4]. A systematic review and metaanalysis was performed to evaluate the impact of early start of vasopressin support within 6 hours after the diagnosis on clinical outcomes in septic shock patients
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