Dopamine therapy in septic shock: detrimental effect on survival?
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.
Boulain
Thierry
T
Service de Réanimation Médicale Polyvalente, Centre Hospitalier Régional d'Orléans, 45067 Orleans Cedex, France.thierry.boulain@chr-orleans.fr
Runge
Isabelle
I
Bercault
Nicolas
N
Benzekri-Lefevre
Dalila
D
Wolf
Manuel
M
Fleury
Christian
C