Key result
Dopamine use as a vasopressor was associated with significantly higher in-hospital mortality compared to no dopamine use (22.5% vs. 17.4%) in critically ill patients.
Why the study?
Dopamine is still used for shock in intensive care units worldwide despite evidence against its use, prompting an evaluation of current Japanese practice and the consequences of its use in a large Asian population.
Does dopamine use compared to noradrenaline affect in-hospital mortality in critically ill ICU patients?
Cohort (n=14,594)
Yes
Does dopamine use compared to noradrenaline affect in-hospital mortality in critically ill ICU patients?
Answers are grounded in this paper and cite their sources.
Despite guidelines recommending against its use, dopamine remains widely used in Japanese ICUs and is associated with increased in-hospital mortality compared to noradrenaline when used as a vasopressor.
BACKGROUND: Dopamine is used to treat patients with shock in intensive care units (ICU) throughout the world, despite recent evidence against its use. The aim of this study was to identify the latest practice of dopamine use in Japan and also to explore the consequences of dopamine use in a large Asian population. METHODS: The Japanese Intensive Care PAtient Database (JIPAD), the largest intensive care database in Japan, was utilized. Inclusion criteria included: 1) age 18 years or older, 2) admitted to the ICU for reasons other than procedures, 3) ICU length of stay of 24 h or more, and 4) treatment with either dopamine or noradrenaline within 24 h of admission. The primary outcome was in-hospital mortality. Multivariable regression analysis was performed, followed by a propensity score-matched analysis. RESULTS: Of the 132,354 case records, 14,594 records from 56 facilities were included in this analysis. Dopamine was administered to 4,653 patients and noradrenaline to 11,844. There was no statistically significant difference in facility characteristics between frequent dopamine users (N = 28) and infrequent users (N = 28). Patients receiving dopamine had more cardiovascular diagnosis codes (70% vs. 42%; p < 0.01), more post-elective surgery status (60% vs. 31%), and lower APACHE III scores compared to patients given noradrenaline alone (70.7 vs. 83.0; p < 0.01). Multivariable analysis showed an odds ratio for in-hospital mortality of 0.86 [95% CI: 0.71-1.04] in the dopamine ≤ 5 μg/kg/min group, 1.46 [95% CI: 1.18-1.82] in the 5-15 μg/kg/min group, and 3.30 [95% CI: 1.19-9.19] in the > 15 μg/kg/min group. In a 1:1 propensity score matching for dopamine use as a vasopressor (570 pairs), both in-hospital mortality and ICU mortality were significantly higher in the dopamine group compared to no dopamine group (22.5% vs. 17.4%, p = 0.038; 13.3% vs. 8.8%, p = 0.018), as well as ICU length of stay (mean 9.3 days vs. 7.4 days, p = 0.004). CONCLUSION: Dopamine is still widely used in Japan. The results of this study suggest detrimental effects of dopamine use specifically at a high dose. Trial registration Retrospectively registered upon approval of the Institutional Review Board and the administration office of JIPAD.
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Suzuki et al. (2022) conducted a cohort in Critically ill patients requiring vasopressors or inotropes (n=14,594). Dopamine vs. No dopamine (Noradrenaline) was evaluated on In-hospital mortality (propensity score-matched for vasopressor dose) (p=0.038). Dopamine use as a vasopressor was associated with significantly higher in-hospital mortality compared to no dopamine use (22.5% vs. 17.4%) in critically ill patients.
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