Dopamine versus norepinephrine in the treatment of septic shock: a meta-analysis*.
OBJECTIVE
There has long-been controversy about the possible superiority of norepinephrine compared to dopamine in the treatment of shock. The objective was to evaluate the effects of norepinephrine and dopamine on outcome and adverse events in patients with septic shock.


METHODS
A systematic search of the MEDLINE, Embase, Scopus, and CENTRAL databases, and of Google Scholar, up to June 30, 2011.


METHODS
All studies providing information on the outcome of patients with septic shock treated with dopamine compared to norepinephrine were included. Observational and randomized trials were analyzed separately. Because time of outcome assessment varied among trials, we evaluated 28-day mortality or closest estimate. Heterogeneity among trials was assessed using the Cochrane Q homogeneity test. A Forest plot was constructed and the aggregate relative risk of death was computed. Potential publication bias was evaluated using funnel plots.


RESULTS
We retrieved five observational (1,360 patients) and six randomized (1,408 patients) trials, totaling 2,768 patients (1,474 who received norepinephrine and 1,294 who received dopamine). In observational studies, among which there was significant heterogeneity (p < .001), there was no difference in mortality (relative risk, 1.09; confidence interval, 0.84-1.41; p = .72). A sensitivity analysis identified one trial as being responsible for the heterogeneity; after exclusion of that trial, no heterogeneity was observed and dopamine administration was associated with an increased risk of death (relative risk, 1.23; confidence interval, 1.05-1.43; p < .01). In randomized trials, for which no heterogeneity or publication bias was detected (p = .77), dopamine was associated with an increased risk of death (relative risk, 1.12; confidence interval, 1.01-1.20; p = .035). In the two trials that reported arrhythmias, these were more frequent with dopamine than with norepinephrine (relative risk, 2.34; confidence interval, 1.46-3.77; p = .001).


CONCLUSIONS
In patients with septic shock, dopamine administration is associated with greater mortality and a higher incidence of arrhythmic events compared to norepinephrine administration.
Department of Intensive Care, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium. ddebacke@ulb.ac.be
Daniel
D
De Backer
Cesar
C
Aldecoa
Hassane
H
Njimi
Jean-Louis
JL
Vincent
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D004298:Dopamine / Q000627:therapeutic use*; D015259:Dopamine Agents / Q000627:therapeutic use*; D006801:Humans; D009638:Norepinephrine / Q000627:therapeutic use*; D012772:Shock, Septic / Q000188:drug therapy*
D000316:Adrenergic alpha-Agonists; D015259:Dopamine Agents; D004298:Dopamine; D009638:Norepinephrine