title: 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.
authors.affiliation: Kidney Institute and Division of Nephrology, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Che-Yi
authors.initials: CY
authors.lastname: Chou
authors.forename: Hung-Chieh
authors.initials: HC
authors.lastname: Yeh
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
authors.forename: Jiung-Hsiun
authors.initials: JH
authors.lastname: Liu
authors.forename: Hsin-Hung
authors.initials: HH
authors.lastname: Lin
authors.forename: Yao-Lung
authors.initials: YL
authors.lastname: Liu
authors.forename: Ya-Fei
authors.initials: YF
authors.lastname: Yang
authors.forename: Shu-Ming
authors.initials: SM
authors.lastname: Wang
authors.forename: Chiu-Ching
authors.initials: CC
authors.lastname: Huang
mesh_terms: D018806:APACHE; D000368:Aged; D000369:Aged, 80 and over; D002395:Catecholamines / Q000627:therapeutic use; D016638:Critical Illness / Q000401:mortality*; D004298:Dopamine / Q000627:therapeutic use; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use*; D017582:Renal Replacement Therapy / Q000401:mortality*; D012189:Retrospective Studies; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D002395:Catecholamines; D014662:Vasoconstrictor Agents; D004298:Dopamine; D009638:Norepinephrine