Norepinephrine and Hospital Mortality in Critically Ill Patients Undergoing Continuous Renal Replacement Therapy

Abstract

High-dose vasopressor use is associated with increasing mortality in patients with septic shock. We conducted this study to determine if the high-dose of vasopressor used before the initiation of continuous renal replacement therapy (CRRT) is associated with increasing mortality in critically ill patients. We retrospectively reviewed all patients who underwent CRRT in the medical intensive care unit of China Medical University Hospital between 2003 and 2007. The association between mortality and highest vasopressors (dopamine and norepinephrine [NE]) dose used were analyzed using Kaplan-Meier analysis and multivariate Cox regression. A total of 279 patients (170 men and 109 women) treated with CRRT in medical intensive care were reviewed and 237 (84.9%) died. In Kaplan-Meier analysis with log-rank test, dopamine dose of ≥20 µg/kg/min and NE dose of ≥0.3 µg/kg/min were significantly linked to mortality (P = 0.007 and <0.001). In multivariate Cox proportional hazards regression, NE dose of ≥0.3 µg/kg/min, Acute Physiology and Chronic Health Evaluation II score, and low platelet count were independently linked to mortality. The hazard ratios and 95% confidence interval (CI) were 1.771 (95% CI: 1.247-2.516, P = 0.001), 1.035 (95% CI: 1.012-1.058, P = 0.003), and 0.997 (95% CI: 0.996-0.999, P = 0.003), respectively. Critically ill patients treated with very high dose of NE before the initiation of CRRT have a very high mortality rate regardless of the acute kidney injury stage.

Development of a new mortality scoring system for acute kidney injury with continuous renal replacement therapy

“…Several factors are associated with high mortality during CRRT. The physical condition of patients undergoing CRRT is already poor, and most of them have multiple comorbidities including sepsis and problems with the heart and lungs . The seven significant variables that were selected for the MOSAIC model incorporated hypotension, respiratory failure, unconsciousness, electrolyte and acid–base imbalance, liver dysfunction, and adverse immune response.…”

“…The physical condition of patients undergoing CRRT is already poor, and most of them have multiple comorbidities including sepsis and problems with the heart and lungs. [23][24][25][26] The seven significant variables that were selected for the MOSAIC model incorporated hypotension, respiratory failure, unconsciousness, electrolyte and acidbase imbalance, liver dysfunction, and adverse immune response. However, serum creatinine was not a relevant factor in high mortality, which suggests that the original prediction models needed modification.…”

The organ preservation and enhancement of donation success ratio effect of extracorporeal membrane oxygenation in circulatory unstable brain death donor

“…If the target MAP could not be achieved, the large dose of vasoactive drug would result in resuscitation failure and severe adverse effects. A clinical study showed dopamine in dose of ≥20 μg/kg/min and NE in dose of ≥0.3 μg/kg/min were significantly linked to increased mortality in critically ill patients . ECMO can provide respiratory and circulatory support to DBD donor, thus avoiding liver and kidney function damage caused by vasoactive drugs.…”

Comparison of hemodynamic parameters among continuous, intermittent and hybrid renal replacement therapy in acute kidney injury: a systematic review of randomized clinical trials

“…Previous studies have reported that high-dose vasopressor is associated with increased mortality. Study from Wang et al [30] found that norepinephrine doses equal or above 0.3 μg/kg/min were independently linked to mortality, HR 1.77 (95% IC 1.23 to 2.52, P = 0.001). Critically ill patients treated with high doses of norepinephrine before the initiation of CRRT have a very high mortality rate regardless of the stage of the AKI [30].…”