Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2012 Aug 14;16(4):R154.
doi: 10.1186/cc11469.

Vasopressin and terlipressin in adult vasodilatory shock: a systematic review and meta-analysis of nine randomized controlled trials

Ary Serpa Neto, Antônio P Nassar, Sérgio O Cardoso, José A Manetta, Victor G M Pereira, Daniel C Espósito, Maria C T Damasceno, James A Russell
Meta-Analysis

Vasopressin and terlipressin in adult vasodilatory shock: a systematic review and meta-analysis of nine randomized controlled trials

Ary Serpa Neto et al. Crit Care. .

Abstract

Introduction: Catecholamines are the most used vasopressors in vasodilatory shock. However, the development of adrenergic hyposensitivity and the subsequent loss of catecholamine pressor activity necessitate the search for other options. Our aim was to evaluate the effects of vasopressin and its analog terlipressin compared with catecholamine infusion alone in vasodilatory shock.

Methods: A systematic review and meta-analysis of publications between 1966 and 2011 was performed. The Medline and CENTRAL databases were searched for studies on vasopressin and terlipressin in critically ill patients. The meta-analysis was limited to randomized controlled trials evaluating the use of vasopressin and/or terlipressin compared with catecholamine in adult patients with vasodilatory shock. The assessed outcomes were: overall survival, changes in the hemodynamic and biochemical variables, a decrease of catecholamine requirements, and adverse events.

Results: Nine trials covering 998 participants were included. A meta-analysis using a fixed-effect model showed a reduction in norepinephrine requirement among patients receiving terlipressin or vasopressin infusion compared with control (standardized mean difference, -1.58 (95% confidence interval, -1.73 to -1.44); P < 0.0001). Overall, vasopressin and terlipressin, as compared with norepinephrine, reduced mortality (relative risk (RR), 0.87 (0.77 to 0.99); P = 0.04). Vasopressin compared with norepinephrine decreased mortality in adult patients (RR, 0.87 (0.76 to 1.00); P = 0.05) and in patients with septic shock (42.5% vs. 49.2%, respectively; RR, 0.87 (0.75 to 1.00); P = 0.05; number needed to treat, 1 to 15). There was no difference in adverse events between the vasopressin and control groups (RR, 0.98 (0.65 to 1.47); P = 0.92).

Conclusions: Vasopressin use in vasodilatory shock is safe, associated with reduced mortality, and facilitates weaning of catecholamines. In patients with septic shock, use of vasopressin compared with norepinephrine may also decrease mortality.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Literature search strategy. AVP, vasopressin.
Figure 2
Figure 2
Standardized mean difference for norepinephrine reduction between vasopressin/terlipressin and control. Vasopressin (AVP) and terlipressin (TP) was associated with a significantly standardized mean difference with control (P < 0.0001 for both comparisons). CI, confidence interval; SD, standard deviation.
Figure 3
Figure 3
Meta-analysis of overall survival for vasopressin, norepinephrine and terlipressin combined analyses. Meta-analysis of overall survival for vasopressin (AVP) + norepinephrine (NE) or terlipressin (TP) + NE in vasodilatory shock, and for AVP + NE in septic shock. CI, confidence interval; M-H, Mantel and Haenszel.
See this image and copyright information in PMC

Comment in

References

    1. Landry DW, Oliver JA. The pathogenesis of vasodilatory shock. N Engl J Med. 2001;345:588–595. doi: 10.1056/NEJMra002709. - DOI - PubMed
    1. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL. International Surviving Sepsis Campaign Guidelines Committee; American Association of Critical-Care Nurses; American College of Chest Physicians; American College of Emergency Physicians; Canadian Critical Care Society; European Society of Clinical Microbiology and Infectious Diseases et al.Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36:296–327. doi: 10.1097/01.CCM.0000298158.12101.41. - DOI - PubMed
    1. Mullner M, Urbanek B, Havel C, Losert H, Waechter F, Gamper G. Vasopressors for shock. Cochrane Database Syst Rev. 2004;3:CD003709. - PubMed
    1. Holmes CL, Walley KR. Vasopressin in the ICU. Curr Opin Crit Care. 2004;10:442–448. doi: 10.1097/01.ccx.0000144769.19213.0c. - DOI - PubMed
    1. Sutton AJ, Higgins JP. Recent developments in meta-analysis. Stat Med. 2008;27:625–650. doi: 10.1002/sim.2934. - DOI - PubMed

Publication types