Background
Methods
Registration and protocol
Inclusion criteria
Data source and literature search
Study selection and data extraction
Study quality evaluation
Statistical analysis
Results
Literature selection process
The characteristics and quality of the included studies
Study | Year | No. of patients | Patients | Intervention | Comparison | Outcome |
---|---|---|---|---|---|---|
Malay | 1999 | 10 | Septic shock | Vasopressin 0.04 U/min | NE | 24 h |
Albanese | 2005 | 20 | Septic shock | Terlipressin: one bolus of 1 mg and a second bolus of 1 mg was given if the MAP < 65 mmHg after 20 mins | NE was started at a dose of 0.3 μg/kg/min, followed by 0.3 μg/kg/min increments at 4-min intervals to raise MAP to 65 to 75 mmHg | Hospital |
Lauzier | 2006 | 23 | Septic shock | Arginine-vasopressin 0.04–0.20 U/min | NE 0.1–2.8 μg/kg/min | ICU |
Russell | 2008 | 799 | Septic shock | Vasopressin 0.01–0.03 U/min or at clinician’s discretion | NE 5 to 15 mg/min or at clinician’s discretion | 90 days |
Acevedo | 2009 | 24 | Septic shock and cirrhosis | Terlipressin 1–2 mg/4 h plus alpha-adrenergic drugs | Alpha-adrenergic drugs alone | Hospital |
Morelli | 2009 | 45 | Septic shock | Terlipressin 1.3 μg/kg/h Vasopressin 0.03 U/min | NE 15 μg/min | ICU |
Han | 2012 | 139 | Septic shock | Pituitrin 1.0–2.5 U/h | Dopamine or NE 2–20 μg/kg/h | 28 days |
Svoboda | 2012 | 30 | Septic shock | Terlipressin 4 mg/24 h for 72 h plus open-label norepinephrine | NE > 0.6 μg/kg/min for more than 24 h | 28 days |
Fonseca Ruiz | 2013 | 30 | Septic shock | Vasopressin 0.01–0.04 U/min plus NE | NE | 28 days |
Hua | 2013 | 32 | Septic shock patients with ARDS | Terlipressin 1.3 mg/kg/h | Dopamine < 20 mg/kg/min | 28 days |
Oliveira | 2014 | 387 | Septic shock | Vasopressin 0.01–0.03 U/min with low doses of norepinephrine | NE 0.05–2.0 μg/kg/min | 28 days |
Barzegar | 2016 | 30 | Septic shock | Vasopressin 0.03 μg/min plus NE | NE: infusion adjusted to MAP ≥ 65 mmHg | 28 days |
Choudhury | 2016 | 84 | Cirrhotics with septic shock | Terlipressin 2–8 mg over 24 h | NE 7.5–60 μg/min | 28 days |
Clem | 2016 | 82 | Septic shock | Vasopressin 0.04 U/min plus NE with 0.05–0.5 μg/kg/min | NE 0.05 to 0.5 μg/kg/min | 28 days |
Gordon | 2016 | 408 | Septic shock | Vasopressin: titrated up to 0.06 U/min to maintain the MAP 65 to 75 mmHg | NE: titrated up to 12 μg/min to maintain the MAP 65 to 75 mmHg | 28 days |
Capoletto | 2017 | 250 | Septic shock and cancer | Vasopressin | NE | 90 days |
Chen | 2017 | 57 | Septic shock patients with ARDS | Terlipressin 0.01–0.04 U/min to maintain MAP between 65 and 75 mmHg, if necessary plus NE | NE > 1 μg/min to maintain MAP between 65 and 75 mmHg | 28 days |
Prakash | 2017 | 184 | Cirrhosis with septic shock. | Terlipressin 2 mg/24 h and 3.75–30 μg/min of NE as needed to maintain MAP > 65 mmHg | NE 7.5–60 μg/min | 30 days |
Russell | 2017 | 48 | Septic shock | Selepressin 1.25, 2.5, and 3.75 ng/kg/min until shock resolution or a maximum of 7 days | Placebo | 28 days |
Liu | 2018 | 535 | Septic shock | Terlipressin 20–160 μg/h | NE 4–30 μg/min | 28 days |
Meta-analysis
The primary endpoint: mortality
Post hoc sensitive and subgroup analysis
The secondary endpoints
ICU length of stay
Duration of mechanical ventilation
Adverse events
Total adverse events
Digital ischemia
Other adverse events
Indicator | Vasopressin | Vasopressin’s analogues |
---|---|---|
ICU length of stay (MD) | − 0.17 (95% CI − 0.98–0.63, P = 0.67, I2 = 0%) | 0.03 (95% CI − 0.87–0.93, P = 0.94, I2 = 24%) |
Duration of MV (MD) | − 1.00 (95% CI −2.39-0.39, P = 0.16)* | − 0.50 (95% CI − 1.57–0.57, P = 0.36, I2 = 63%) |
Total adverse events (RR) | 1.13 (95% CI 0.83–1.53, P = 0.43, I2 = 0%) | 1.20 (95% CI 0.52–2.74, P = 0.67, I2 = 79%) |
Digital ischemia (RR) | 3.33 (95% CI 1.39–7.95, P < 0.001, I2 = 0%) | 6.06 (95% CI 2.97–12.37, P < 0.001, I2 = 68%) |
Cardiovascular events (RR) | 0.93 (95% CI 0.51–1.69, P = 0.80, I2 = 27%) | 0.84 (95% CI 0.24–2.99, P = 0.79, I2 = 0%) |
Arrhythmia (RR) | 0.99 (95% CI 0.51–1.91, P = 0.98, I2 = 15%) | 0.57 (95% CI 0.29–1.15, P = 0.12, I2 = 35%) |
Mesenteric ischemia (RR) | 0.77 (95% CI 0.38–1.53, P = 0.45, I2 = 0%) | 1.22 (95% CI 0.26–5.64, P = 0.80, I2 = 42%) |
Diarrhea (RR) | 0.98 (95% CI 0.06–15.58)* | 1.64 (95% CI 0.05–54.19, P = 0.78, I2 = 71%) |
Cerebrovascular events (RR) | 0.98 (95% CI 0.06–15.58, P = 0.99)* | 2.00 (95% CI 0.09–46.68, P = 0.67)* |
Hyponatremia (RR) | 2.31 (95% CI 0.35–15.09, P = 0.38, I2 = 0%) | 1.39 (95% CI 0.78–2.49, P = 0.26)* |