Norepinephrine dose and concentration reporting: the devil is in the details

Kattan, Eduardo; Ibarra-Estrada, Miguel; Jung, Christian

doi:10.1007/s00134-024-07446-z

Cited by 2 publications

(2 citation statements)

References 9 publications

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“…In fact, two large surveys showed that around 50% of respondents are unaware of on which formulation is NE reported locally and, therefore, administered in their practice [ 12 ], leading to potential guideline interpretation disagreements between practitioners [ 13 ]. This variability could hinder the correct application of time-sensitive clinical interventions, the comparison of results between centers, and multicentric research initiatives [ 2 , 4 , 11 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

The impact of norepinephrine dose reporting heterogeneity on mortality prediction in septic shock patients

Morales,

Wendel-Garcia,

Ibarra-Estrada

et al. 2024

Crit Care

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Background Norepinephrine (NE) is a cornerstone drug in the management of septic shock, with its dose being used clinically as a marker of disease severity and as mortality predictor. However, variations in NE dose reporting either as salt formulations or base molecule may lead to misinterpretation of mortality risks and hinder the process of care. Methods We conducted a retrospective analysis of the MIMIC-IV database to assess the impact of NE dose reporting heterogeneity on mortality prediction in a cohort of septic shock patients. NE doses were converted from the base molecule to equivalent salt doses, and their ability to predict 28-day mortality at common severity dose cut-offs was compared. Results 4086 eligible patients with septic shock were identified, with a median age of 68 [57–78] years, an admission SOFA score of 7 [6–10], and lactate at diagnosis of 3.2 [2.4–5.1] mmol/L. Median peak NE dose at day 1 was 0.24 [0.12–0.42] μg/kg/min, with a 28-day mortality of 39.3%. The NE dose showed significant heterogeneity in mortality prediction depending on which formulation was reported, with doses reported as bitartrate and tartrate presenting 65 (95% CI 79–43)% and 67 (95% CI 80–47)% lower ORs than base molecule, respectively. This divergence in prediction widened at increasing NE doses. When using a 1 μg/kg/min threshold, predicted mortality was 54 (95% CI 52–56)% and 83 (95% CI 80–87)% for tartrate formulation and base molecule, respectively. Conclusions Heterogeneous reporting of NE doses significantly affects mortality prediction in septic shock. Standardizing NE dose reporting as base molecule could enhance risk stratification and improve processes of care. These findings underscore the importance of consistent NE dose reporting practices in critical care settings.

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Section: Introductionmentioning

confidence: 99%

The impact of norepinephrine dose reporting heterogeneity on mortality prediction in septic shock patients

Morales,

Wendel-Garcia,

Ibarra-Estrada

et al. 2024

Crit Care

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“…For the case of norepinephrine, it is considered an efficacy-driven agonist, meaning that the resulting signals are less attenuated in tissues with lower α 1 -adrenergic receptor density, compared to affinity-driven agonists (i.e., oxymetazoline) that will become partial agonists or even antagonists in states of lower receptor density [3]. In the article, we avoided to focus on deeper pharmacologic nuances and did not elaborate on the concept of potency; and as mentioned in a response letter [4], we preferred to simplify terms to stress the need for standardized formulation reporting on clinical grounds.…”

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confidence: 99%

Norepinephrine dose reporting: are we looking at different sides of the same coin?

Ibarra-Estrada,

Kattan,

Jung

2024

Intensive Care Med

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Norepinephrine dose and concentration reporting: the devil is in the details

Cited by 2 publications

References 9 publications

The impact of norepinephrine dose reporting heterogeneity on mortality prediction in septic shock patients

The impact of norepinephrine dose reporting heterogeneity on mortality prediction in septic shock patients

Norepinephrine dose reporting: are we looking at different sides of the same coin?

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