Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile.
Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Crit Care. 2024 Jul 3;28(1):216. doi: 10.1186/s13054-024-05011-0.
Norepinephrine (NE) is a cornerstone drug in the management of septic shock, with its dose being used clinically as a marker of disease severity and as mortality predictor. However, variations in NE dose reporting either as salt formulations or base molecule may lead to misinterpretation of mortality risks and hinder the process of care.
We conducted a retrospective analysis of the MIMIC-IV database to assess the impact of NE dose reporting heterogeneity on mortality prediction in a cohort of septic shock patients. NE doses were converted from the base molecule to equivalent salt doses, and their ability to predict 28-day mortality at common severity dose cut-offs was compared.
4086 eligible patients with septic shock were identified, with a median age of 68 [57-78] years, an admission SOFA score of 7 [6-10], and lactate at diagnosis of 3.2 [2.4-5.1] mmol/L. Median peak NE dose at day 1 was 0.24 [0.12-0.42] μg/kg/min, with a 28-day mortality of 39.3%. The NE dose showed significant heterogeneity in mortality prediction depending on which formulation was reported, with doses reported as bitartrate and tartrate presenting 65 (95% CI 79-43)% and 67 (95% CI 80-47)% lower ORs than base molecule, respectively. This divergence in prediction widened at increasing NE doses. When using a 1 μg/kg/min threshold, predicted mortality was 54 (95% CI 52-56)% and 83 (95% CI 80-87)% for tartrate formulation and base molecule, respectively.
Heterogeneous reporting of NE doses significantly affects mortality prediction in septic shock. Standardizing NE dose reporting as base molecule could enhance risk stratification and improve processes of care. These findings underscore the importance of consistent NE dose reporting practices in critical care settings.
去甲肾上腺素（NE）是脓毒性休克治疗的基石药物，其剂量被临床用作疾病严重程度的标志物和死亡率预测指标。然而，NE 剂量以盐制剂或碱分子形式报告的差异可能导致对死亡率风险的误解，并阻碍治疗过程。
我们对 MIMIC-IV 数据库进行了回顾性分析，以评估脓毒性休克患者队列中 NE 剂量报告异质性对死亡率预测的影响。将 NE 剂量从碱分子转换为等效盐剂量，并比较了它们在常见严重程度剂量截止值下预测 28 天死亡率的能力。
确定了 4086 名符合条件的脓毒性休克患者，中位年龄为 68 [57-78] 岁，入院 SOFA 评分为 7 [6-10]，诊断时的乳酸为 3.2 [2.4-5.1]mmol/L。第 1 天的峰值 NE 剂量中位数为 0.24 [0.12-0.42]μg/kg/min，28 天死亡率为 39.3%。NE 剂量在死亡率预测方面表现出显著的异质性，具体取决于报告的制剂，以酒石酸盐和酒石酸氢盐报告的 OR 分别比碱分子低 65（95%CI 79-43）%和 67（95%CI 80-47）%。这种预测的差异在 NE 剂量增加时扩大。当使用 1μg/kg/min 阈值时，酒石酸盐制剂和碱分子的预测死亡率分别为 54（95%CI 52-56）%和 83（95%CI 80-87）%。
NE 剂量的异质性报告显著影响脓毒性休克的死亡率预测。将 NE 剂量报告标准化为碱分子可以增强风险分层并改善治疗过程。这些发现强调了在重症监护环境中保持一致的 NE 剂量报告实践的重要性。
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