Norepinephrine Administration Is Associated with Higher Mortality in Dialysis Requiring Acute Kidney Injury Patients with Septic Shock

作者：Chen, Ying-Ying; Wu, Vin-Cent; Huang, Wei-Chieh; Yeh, Yu-Chang; Wu, Mai-Szu; Huang, Chiu-Ching; Wu, Kwan-Dun; Fang, Ji-Tseng; Wu, Chih-Jen

来源：Journal of Clinical Medicine, 2018, 7(9): 274.

DOI：10.3390/jcm7090274

• critical care
• vasoactive agents
• norepinephrine
• sepsis
• acute kidney injury
• dialysis

(1) Background: Norepinephrine (NE) is the first-line vasoactive agent used in septic shock patients; however, the effect of norepinephrine on dialysis-required septic acute kidney injury (AKI-D) patients is uncertain. (2) Methods: To evaluate the impact of NE on 90-day mortality and renal recovery in septic AKI-D patients, we enrolled patients in intensive care units from 30 hospitals in Taiwan. (3) Results: 372 patients were enrolled and were divided into norepinephrine users and non-users. After adjustment by Inverse probability of treatment weighted (IPTW), there was no significant difference of baseline comorbidities between the two groups. NE users had significantly higher 90-day mortality rate and using NE is a strong predictor of 90-day mortality in the multivariate Cox regression (HR = 1.497, p = 0.027) after adjustment. The generalized additive model disclosed norepinephrine alone exerted a dose-dependent effect on 90-day mortality, while other vasoactive agents were not. (4) Conclusion: Using norepinephrine in septic AKI-D patients is associated with higher 90-day mortality and the effect is dose-dependent. Further study to explore the potential mechanism is needed.

• 出版日期2018-9
• 单位中国医科大学; 河北医科大学; 长春大学