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Review
. 2022 May 25;8(3):185-199.
eCollection 2022 Jun 29.

Vasopressin versus norepinephrine as the first-line vasopressor in septic shock: A systematic review and meta-analysis

Yub Raj Sedhai  1 , Dhan Bahadur Shrestha  2 , Pravash Budhathoki  3 , Waqas Memon  4 , Roshan Acharya  5 , Suman Gaire  6 , Nisheem Pokharel  7 , Swojay Maharjan  8 , Ranjit Jasaraj  2 , Amik Sodhi  9 , Dipen Kadariya  10 , Ankush Asija  11 , Markos G Kashiouris  12
Affiliations
Review

Vasopressin versus norepinephrine as the first-line vasopressor in septic shock: A systematic review and meta-analysis

Yub Raj Sedhai et al. J Clin Transl Res. .

Abstract

Background and aim: Norepinephrine is currently the first-line vasopressor for septic shock. We conducted this meta-analysis to examine the outcomes of adult patients with septic shock who received vasopressin instead of norepinephrine.

Methods: We selected studies in adults with septic shock that compared the outcomes of patients treated with vasopressin versus norepinephrine. Cochrane ROB 2.0 and the Joanna Briggs Institute quality assessment tools were used to assess the risk of bias in RCTs and observational studies. Meta-analysis was conducted using RevMan 5.4.

Results: Eight studies were included in this meta-analysis. There were no significant differences in 28-day mortality rates (OR, 1.07; CI, 0.80-1.44) and intensive care unit (ICU) mortality (OR, 0.74; CI, 0.21-2.67) between the two groups. Similarly, length of ICU stay, length of hospital stay, mean arterial pressure at 24 h, urine output at 24 h, and serious adverse events also did not differ significantly. However, the odds of renal replacement therapy (RRT) requirement in the vasopressin group were substantially lower than in the norepinephrine group (OR, 0.68; CI, 0.47-0.98).

Conclusion: There were no differences in mortality, duration of hospitalization, and adverse effects in adults with septic shock across the two groups. However, the patients treated with vasopressin had lower chances of requiring RRT.

Relevance for patients: Vasopressin use as the first-line vasopressor in septic shock showed a significant reduction in RRT, though there were no significant differences in terms of mortality and other adverse events. Therefore, vasopressin can be considered as a first-line vasopressor in septic shock patients with other risk factors which may contribute to renal failure requiring RRT.

Keywords: norepinephrine; outcomes; renal replacement; septic shock; vasopressin.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1. Cochrane ROB bias assessment.
Figure 2
Figure 2. Preferred Reporting Items for Systematic Reviews and Meta-analyses flow diagram.
Figure 3
Figure 3. Forest plot comparing mortality outcome across vasopressin and norepinephrine in septic shock patients.
Figure 4
Figure 4. Forest plot comparing the length of intensive care unit stay and hospital stay across vasopressin and norepinephrine in septic shock patients.
Figure 5
Figure 5. Forest plot comparing mean arterial pressure across vasopressin and norepinephrine in septic shock patients.
Figure 6
Figure 6. Forest plot comparing urine output (ml/h) across vasopressin and norepinephrine in septic shock patients.
Figure 7
Figure 7. Forest plot comparing SAE across vasopressin and norepinephrine in septic shock patients.
Figure 8
Figure 8. Forest plot comparing requirement of renal replacement therapy across vasopressin and norepinephrine in septic shock patients.
Figure 1
Figure 1
Forest plot showing mortality outcome after excluding non-randomized study.
Figure 2
Figure 2
Forest plot showing LOS outcome after excluding non-randomized study.
Figure 3
Figure 3
Forest plot showing urine output after excluding non-randomized study.
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