Clinical Efficiency of Vasopressin or Its Analogs in Comparison With Catecholamines Alone on Patients With Septic Shock: A Systematic Review and Meta-Analysis

Yao, Ren-qi; Xia, Demeng; Wang, Lixue; Wu, Guosheng; Zhu, Yibing; Zhao, Hong; Liu, Qi; Xia, Zhaofan; Yao, Yong-ming

doi:10.3389/fphar.2020.00563

Cited by 12 publications

(11 citation statements)

References 52 publications

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“…Yao et al. 26 found no association between vasopressin use and overall incidence of adverse events or arrhythmias. Higher incidence of digital ischemia was shown in their meta-analysis which may be reflective of patients in those studies having shock, concomitant catecholamine use, or vasopressin.…”

Section: Discussionmentioning

confidence: 97%

Vasopressin for Post-kidney Transplant Hypotension

Jan

Moe

Adebiyi

et al. 2022

Kidney International Reports

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Section: Discussionmentioning

confidence: 97%

Vasopressin for Post-kidney Transplant Hypotension

Jan

Moe

Adebiyi

et al. 2022

Kidney International Reports

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“…As the adverse effects of vasopressin, ischemia events, such as digital ischemia ( 6 , 7 ), mesenteric ischemia ( 8 , 9 ), myocardial ischemia, and alterations in circulation dynamics ( 10 ) may be induced by strong vasoconstriction. However, recent clinical studies suggested that these adverse events are less frequent than previously reported, except for digital ischemia, when the appropriate dosage is administered ( 11 , 12 ).…”

Section: Introductionmentioning

confidence: 83%

“…High-dose vasopressin may induce digital ( 6 , 7 ), mesenteric ( 8 , 9 ), and myocardial ischemia ( 10 ). Previous case series and clinical trials suggested that the administration of more than 0.05 U/min increased the risk of these adverse effects ( 11 ), and, thus, <0.03 U/min is recommended ( 5 ). However, few studies have investigated the effects of a vasopressin bolus.…”

Section: Discussionmentioning

confidence: 99%

Vasopressin Loading for Refractory Septic Shock: A Preliminary Analysis of a Case Series

et al. 2021

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Background: Vasopressin is one of the strong vasopressor agents associated with ischemic events. Responses to the administration of vasopressin differ among patients with septic shock. Although the administration of a high dose of vasopressin needs to be avoided, the effects of bolus loading have not yet been examined. Since the half-life of vasopressin is longer than that of catecholamines, we hypothesized that vasopressin loading may be effective for predicting responses to its continuous administration.Methods: We retrospectively analyzed consecutive cases of septic shock for which vasopressin was introduced with loading under noradrenaline at >0.2 μg/kg/min during the study period. Vasopressin was administered in a 1 U bolus followed by its continuous administration at 1 U/h. The proportion of patients with a negative catecholamine index (CAI) change 6 h after the introduction of vasopressin was set as the primary outcome. We defined non-responders for exploration as those with a mean arterial pressure change <18 mmHg 1 min after vasopressin loading, among whom none had a change in CAI <0.Results: Twenty-one consecutive cases were examined in the present study, and included 14 responders and 7 non-responders. The primary outcome accounted for 71.4% of responders and 0% of non-responders, with a significant difference (p = 0.0039). Median CAI changes 2, 4, and 6 h after the administration of vasopressin were 0, −5, and −10 in responders and +20, +10, and +10 in non-responders, respectively. CAI was not reduced in any non-responder. Outcomes including mortality were not significantly different between responders and non-responders. Digital ischemia (1/21) and mesenteric ischemia (1/21) were observed.Conclusions: Vasopressin loading may predict responses to its continuous administration in septic shock patients. Further investigations involving a safety analysis are needed.

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“…Two recent systematic reviews with meta-analyses evaluating Vasopressin and its analogs compared to solely using catecholamines found con icting data on the reduction of 28 days mortality (22,45). Nonetheless, there was a pronounced trend for increased risk of digital ischemia in the vasopressin or analogs group.…”

Section: Discussionmentioning

confidence: 99%

Effect of Vasopressin and its Analogs versus Catecholamines on the Renal Outcomes in Septic Shock:A Systematic Review and Meta-Analysis of Randomized Trials

Yusuf

et al. 2021

Preprint

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Background: This current systematic review and meta-analysis aimed to evaluate the association of Vasopressin and its analogs and adverse renal outcomes compared to Catecholamines in adult patients with septic shock. Method: We performed a systematic review of the literature published from inception to March 31, 2021, using online databases of PubMed, Embase, Cochrane Library. Randomized controlled trials reporting any renal function and comparing Vasopressin and its analogs with Catecholamines among adult septic shock patients. Our primary outcomes relating to acute renal failure were acute kidney injury incidence and the need for Renal replacement therapy. Our secondary outcomes were three: Renal replacement therapy free-days and 48h post-administration change in creatinine level and urine output. We applied a fixed-effects model to estimate the risk ratio (RR) for (dichotomized outcomes) and standard mean difference (SMD) for (continues outcomes). Results: 18 trials met the inclusion criteria with a total of 4,024 patients. 13 studies were eligible for quantitative meta-analysis and 5 studies were eligible for qualitative data. For the primary outcome, Vasopressin or its agonist are associated with a lower AKI incidence (Risk ratio 0.93, 95% CI [0.86, 1.00], P = 0.04, I² = 5%) and a reduced need for renal replacement therapy (Risk ratio 0.84, 95% CI [0.73, 0.97], P = 0.02, I² = 11%). We found no statistical significance in the pooled estimates for the secondary outcomes: RRT free-days (28 or 30 days) (P = 0.65, I² = 0%), 48h creatinine level (P = 0.81, I² = 39%), and 48h urine output (P = 0.46, I² = 8%). Conclusions: Vasopressin and its analogs are associated with a reduced AKI incidence and a lower RRT use rate in septic shock compared to catecholamines. Furthermore, we did not find a significant effect of Vasopressin on the number of RRT- free days (up to 28 or 30 days) or in creatinine level and urinary output in 48 hours. However, due to the high mortality associated with S-AKI, large blinded RCTs addressing renal function impairment in septic shock are warranted.

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Clinical Efficiency of Vasopressin or Its Analogs in Comparison With Catecholamines Alone on Patients With Septic Shock: A Systematic Review and Meta-Analysis

Cited by 12 publications

References 52 publications

Vasopressin for Post-kidney Transplant Hypotension

Vasopressin for Post-kidney Transplant Hypotension

Vasopressin Loading for Refractory Septic Shock: A Preliminary Analysis of a Case Series

Effect of Vasopressin and its Analogs versus Catecholamines on the Renal Outcomes in Septic Shock:A Systematic Review and Meta-Analysis of Randomized Trials

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