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Review
. 2023;1(2):10.
doi: 10.1007/s44254-023-00013-7. Epub 2023 Apr 23.

Association of vasopressors with mortality in critically ill patients with COVID-19: a systematic review and meta-analysis

Maria Mermiri #  1 , Georgios Mavrovounis #  2 , Eleni Laou  3 , Nikolaos Papagiannakis  4 , Ioannis Pantazopoulos  2 , Athanasios Chalkias  1   5
Affiliations
Review

Association of vasopressors with mortality in critically ill patients with COVID-19: a systematic review and meta-analysis

Maria Mermiri et al. Anesthesiol Perioper Sci. 2023.

Abstract

Exogenous catecholamines may have pronounced side effects and affect physiological cascades. The aim of this study was to investigate the effect of vasopressors on mortality of critically ill patients with coronavirus disease 2019 (COVID-19). A systematic search of PubMed, Scopus, and ClinicalTrials.gov was conducted for relevant articles until December 2022. Eligibility criteria were randomized controlled and non-randomized trials. The primary outcome was in-hospital and 30-day mortality. The quality of studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) tool, while paired meta-analysis was used to estimate the pooled risk ratios (RR) along with their 95% Confidence Interval (95% CI). Analyses of 22 studies (n = 8034) revealed that vasopressor use is associated with mortality compared to no vasopressor therapy [RR (95%CI): 4.30 (3.21, 5.75); p < 0.001]. In-hospital and 30-day mortality are significantly higher in patients who receive vasopressors [RR (95%CI): 4.60 (2.47, 8.55); p < 0.001 and RR (95%CI): 2.97 (1.72, 5.14); p < 0.001, respectively]. Also, analyses of data from 10 studies (n = 3519) revealed that vasopressor use is associated with acute kidney injury [RR (95%CI): 3.17 (2.21, 4.54); p < 0.001]. In conclusion, current use of vasopressors in critically ill patients with COVID-19 may be associated with higher in-hospital mortality, 30-day mortality, and incidence rate of acute kidney injury. Further research is required to estimate the correlation of specific vasopressor characteristics (type, timing, dose, combination) with adverse effects and mortality in this population.

Supplementary information: The online version contains supplementary material available at 10.1007/s44254-023-00013-7.

Keywords: Covid-19; Critically ill; Hemodynamics; Intensive care; Mortality; Vasopressor.

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Conflict of interest statement

Competing interestsThe author Prof. Dr. Athanasios Chalkias is a member of the Editorial Board in Anesthesiology and Perioperative Science. The paper was handled by the other Editor and had undergone rigorous peer review process. Prof. Dr. Athanasios Chalkias was not involved in the journal's whole peer review procedure of this manuscript. The other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram
Fig. 2
Fig. 2
Effect of vasopressor use on mortality of critically ill patients with COVID-19
Fig. 3
Fig. 3
Effect of vasopressor use on the incidence of acute kidney injury
Fig. 4
Fig. 4
Subgroup analyses based on the definition of acute kidney injury
See this image and copyright information in PMC

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