McIntyre WF, et al. - Researchers evaluated if treatment with vasopressin + catecholamine vasopressors vs catecholamine vasopressors alone was could reduce the risk of adverse events in patients with distributive shock. A lower risk of atrial fibrillation was seen when vasopressin was added to catecholamine vasopressors vs when catecholamines alone were used. For secondary outcomes, findings varied.

Methods

• Authors searched for data in MEDLINE, EMBASE, and CENTRAL up to February 2018, and searched meta-registries and asked experts about ongoing trials.
• Randomized clinical trials comparing vasopressin in combination with catecholamine vasopressors to catecholamines alone which also included patients with distributive shock were identified by pairs of reviewers.
• Data was independently abstracted by two reviewers, and to combine data, a random-effects model was used.
• Atrial fibrillation was the primary outcome, and mortality, requirement for renal replacement therapy (RRT), myocardial injury, ventricular arrhythmia, stroke, and LOS in the intensive care unit and hospital were other outcomes.
• For clinical outcomes and mean differences for LOS, measures of association were reported as risk ratios (RRs).

Results

• As per data, 23 randomized clinical trials were identified (3,088 patients; mean age, 61.1 years [14.2]; women, 45.3%).
• A lower risk of atrial fibrillation associated with vasopressin treatment (RR, 0.77 [95% CI, 0.67 to 0.88]; risk difference [RD], -0.06 [95% CI, -0.13 to 0.01]) was supported by high-quality evidence.
• The overall RR estimate for mortality was 0.89 (95% CI, 0.82 to 0.97; RD, -0.04 [95% CI, -0.07 to 0.00]); but the RR estimate was 0.96 (95% CI, 0.84 to 1.11) when limited to trials at low risk of bias.
• Results demonstrated tha,t for RRT, the overall RR estimate was 0.74 (95% CI, 0.51 to 1.08; RD, -0.07 [95% CI, -0.12 to -0.01]), but experts noted that RR was 0.70 (95% CI, 0.53 to 0.92,P for interaction=.77) in an analysis limited to trials at low risk of bias.
• In the pooled risks for other outcomes, there were no significant differences.