Effect of dobutamine on patients with septic shock: A retrospective nationwide study

抄録

Background: Dobutamine is administered to patients with hypoperfusion associated with septic shock; however, its effect on mortality of septic shock remains unknown. We used a national inpatient database to investigate the effect of dobutamine on patients with septic shock.

Methods: Adults with septic shock who received ≥ 30 mL/kg fluid and ≥10 μg/min noradrenaline and either vasopressin or adrenaline within 1 day after admission from 1 July 2010 to 31 March 2016 were identified by searching the Japanese Diagnosis Procedure Combination database. Stabilized inverse probability weighting analysis using propensity scores was performed to compare all-cause 28-day mortality and length of stay between patients who had and had not received dobutamine.

Results: Of 4747 eligible patients, 1259 had received dobutamine and 3488 had not. All-cause 28-day mortality did not differ significantly between the groups (risk difference, 0.1%; 95% confidence interval [CI], −3.3 to 3.4; P = 0.975). Receipt of dobutamine was significantly associated with longer hospital stay (difference, 3.8; 95% CI, 0.5–7.2; P = 0.024). Subgroup analysis showed that receipt of dobutamine was not significantly associated with length of stay in patients with cardiovascular disease (difference, −5.1 days; 95% CI, −11.7 to 1.5; P = 0.133), or those who received ≥20 μg/min noradrenaline (difference, 0.5 days; 95% CI, −6.8 to 7.7; P = 0.900).

Conclusions: Overall all-cause 28-day mortality in patients with septic shock did not significantly differ between patients who had and had not received dobutamine; however, receipt of dobutamine was significantly associated with longer hospital stay.