title: Dopamine therapy in septic shock: detrimental effect on survival?
abstract: OBJECTIVE
  The aim of this study is to examine the potential impact of dopamine therapy on 28-day mortality in adult septic shock.
  
  
  METHODS
  For 66 months, clinical data, medications taken before admission, doses of catecholamines used, and biological parameters were recorded prospectively in all patients admitted for septic shock. This observational study was followed by (1) post hoc multivariate analyses and (2) risk-adjusted matched cohort study.
  
  
  RESULTS
  In 277 patients (65 +/- 14 years; Simplified Acute Physiology Score II = 54 +/- 19, 28-day mortality = 45%; hospital mortality = 53%), 6 factors were linked to 28-day mortality, including Simplified Acute Physiology Score II (P < .0001) and the use of dopamine (P = .043). In a pair-matched cohort of 132 patients, we observed a higher mortality with dopamine (28-day mortality of 62% vs 41%, respectively; P = .006). Dopamine remained linked to day 28 mortality by conditional logistic analysis (odds ratio = 6.2 [1.5-25]). A strong interaction between essential hypertension and dopamine was found, associated to 81% 28-day mortality in patients having both conditions.
  
  
  CONCLUSIONS
  In our cohort study, dopamine use was linked to mortality as compared to other vasopressor therapies, particularly in patients with essential hypertension. Future randomized studies attempting to compare dopamine with other therapies in septic shock should pay attention to patients with essential hypertension.
authors.affiliation: Service de Réanimation Médicale Polyvalente, Centre Hospitalier Régional d'Orléans, 45067 Orleans Cedex, France.thierry.boulain@chr-orleans.fr
authors.forename: Thierry
authors.initials: T
authors.lastname: Boulain
authors.forename: Isabelle
authors.initials: I
authors.lastname: Runge
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bercault
authors.forename: Dalila
authors.initials: D
authors.lastname: Benzekri-Lefevre
authors.forename: Manuel
authors.initials: M
authors.lastname: Wolf
authors.forename: Christian
authors.initials: C
authors.lastname: Fleury