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

  1. Maria Mermiri
  2. Georgios Mavrovounis
  3. Eleni Laou
  4. Nikolaos Papagiannakis
  5. Ioannis Pantazopoulos
  6. Athanasios Chalkias

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Abstract

Purpose

The effect of vasopressors on mortality of critically ill patients with COVID-19 has not been studied extensively.

Materials and Methods

A systematic search of PubMed, Scopus, and clinicaltrials.gov was conducted for relevant articles until January 2022. Eligibility criteria were randomized controlled and non-randomized trials. The primary outcome was mortality at latest follow-up. The quality of studies was assessed using the MINORS tool. Paired meta-analysis was used to estimate the pooled risk ratios along with their 95% Confidence Interval.

Results

Analyses of 21 studies (n=7900) revealed that vasopressor use is associated with mortality in patients who receive vasopressors compared to those who do not receive vasopressor therapy [RR (95%CI): 4.26 (3.15, 5.76); 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]. The highest mortality rate was observed with vasopressin or epinephrine, while the lowest mortality rate was observed with angiotensin-II. 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].

Conclusion

Vasopressor use was associated with an increase in in-hospital mortality, 30-day mortality, and acute kidney injury in critically ill patients with COVID-19.

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  1. Version published to 10.1101/2022.05.27.22275715v2 on medRxiv
  2. ScreenIT

    SciScore for 10.1101/2022.05.27.22275715: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomization2.1 Inclusion and exclusion criteria: The inclusion criteria of the current systematic review and meta-analysis were: (1) randomized controlled trials (RCTs) and observational studies; (2) critically ill patients admitted to the intensive care (ICU) or high dependency unit (HDU); (3) adults (≥ 18 years old) hospitalized primarily for COVID-19; (4) SARS-CoV-2 infection confirmed by reverse transcription polymerase chain reaction test of nasopharyngeal or oropharyngeal samples; and (5) vasopressor administration.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
    Cochrane Collaboration
    suggested: None

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    4.1 Limitations: This analysis included patients from various settings, i.e., HDU, ICU, and Emergency Department. Consequently, it may have included heterogeneous groups of patients with COVID-19. Due to the lack of randomized controlled trials, the synthesis of all the available knowledge on the specific outcomes was difficult. The level of heterogeneity was high and the conclusions drawn from this review must be cautious and reserved. Additionally, no data from the different studies was available to adjust the resulting odds ratios according to age, comorbidities, the presence of septic shock or other known factors that affect ICU mortality. In addition, most of the secondary outcomes could not be assessed. Another limitation is the heterogeneity of definitions of AKI that were used across different studies. Also, many of the included studies were conducted in retrospective fashion. Finally, we did not include non-English publications.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a protocol registration statement.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  3. Version published to 10.1101/2022.05.27.22275715v1 on medRxiv