Norepinephrine Administration Is Associated with Higher Mortality in Dialysis Requiring Acute Kidney Injury Patients with Septic Shock

Chen, Ying-YingYing-YingChenVIN-CENT WUHuang, Wei-ChiehWei-ChiehHuangYU-CHANG YEHWu, Mai-SzuMai-SzuWuHuang, Chiu-ChingChiu-ChingHuangKWAN-DUN WUFang, Ji-TsengJi-TsengFangWu, Chih-JenChih-JenWuTAI-SHUAN LAIYU-FENG LINI-JUNG TSAICHUN-FU LAITAO-MIN HUANGTZONG-SHINN CHUYUNG-MING CHENChang, Yu-HsingYu-HsingChangLai, Chien-HengChien-HengLaiTseng, Li-JungLi-JungTsengWang, Jian-JhongJian-JhongWangChen, Cheng-YiCheng-YiChenShiao, Chih-ChungChih-ChungShiaoWang, Wei-JieWei-JieWangLin, Jui-HsiangJui-HsiangLinWu, Che-HsiungChe-HsiungWuWu, Chih-JenChih-JenWuLu, Kuo-ChengKuo-ChengLuKan, Wei-ChihWei-ChihKanHuang, Chiu-ChingChiu-ChingHuangChou, Che-YiChe-YiChouYang, Ya-FeiYa-FeiYangTsai, Jen-PiJen-PiTsaiHu, Fu-ChangFu-ChangHuLee, Chien-TeChien-TeLeeChen, Jin-BorJin-BorChenLee, Chih-HsiungChih-HsiungLeeLee, Wen-ChinWen-ChinLeeLi, Lung-ChihLung-ChihLiChen, Te-ChuanTe-ChuanChenLin, Hugo You-HsienHugo You-HsienLinChen, Yung-ChangYung-ChangChenLee, Chin-ChanChin-ChanLeeSun, Chiao-YinChiao-YinSunPan, Heng-ChihHeng-ChihPanChang, Ming-YangMing-YangChangJenq, Chang-ChyiChang-ChyiJenqLin, Chan-YuChan-YuLinChang, Chih-HsiangChih-HsiangChangTsai, Tsung-YuTsung-YuTsaiChen, Cheng-MinCheng-MinChenLin, En-TzuEn-TzuLinLin, Cheng-JuaCheng-JuaLinWu, Pei-ChenPei-ChenWuKuo, Feng-ChiFeng-ChiKuoWeng, Chih-JenChih-JenWengChen, Li-KwangLi-KwangChenSHUEI-LIONG LINWEI-SHUN YANGHsu, Wen-DingWen-DingHsuLeu, Jyh-GangJyh-GangLeuChang, Jui-TingJui-TingChangLiou, Hung-HsiangHung-HsiangLiouHsu, Kuo-HsiungKuo-HsiungHsuWu, Ming-JuMing-JuWuHuang, Chun-TeChun-TeHuangYou, Zi-HongZi-HongYouChang, Chao-FuChao-FuChangChen, Tzen-WenTzen-WenChenChen, Hsi-HsienHsi-HsienChenFAN-CHI CHANGLin, Yen-ChungYen-ChungLinWu, Mai-SzuMai-SzuWuKao, Chih-ChinChih-ChinKaoHung, Szu-ChunSzu-ChunHungKuo, Ko-LinKo-LinKuoWu, Che-HsiungChe-HsiungWuTarng, Der-CherngDer-CherngTarngChen, Jinn-YangJinn-YangChenYang, Chih-YuChih-YuYangLee, Kuo-HuaKuo-HuaLeeKo, Sheng-WenSheng-WenKoThe NSARF, CAKS GroupCAKS GroupThe NSARF2021-09-172021-09-172018-09-122077-0383https://scholars.lib.ntu.edu.tw/handle/123456789/583340(1) Background: Norepinephrine (NE) is the first-line vasoactive agent used in septic shock patients; however, the effect of norepinephrine on dialysis-required septic acute kidney injury (AKI-D) patients is uncertain. (2) Methods: To evaluate the impact of NE on 90-day mortality and renal recovery in septic AKI-D patients, we enrolled patients in intensive care units from 30 hospitals in Taiwan. (3) Results: 372 patients were enrolled and were divided into norepinephrine users and non-users. After adjustment by Inverse probability of treatment weighted (IPTW), there was no significant difference of baseline comorbidities between the two groups. NE users had significantly higher 90-day mortality rate and using NE is a strong predictor of 90-day mortality in the multivariate Cox regression (HR = 1.497, p = 0.027) after adjustment. The generalized additive model disclosed norepinephrine alone exerted a dose⁻dependent effect on 90-day mortality, while other vasoactive agents were not. (4) Conclusion: Using norepinephrine in septic AKI-D patients is associated with higher 90-day mortality and the effect is dose-dependent. Further study to explore the potential mechanism is needed.enacute kidney injury; critical care; dialysis; norepinephrine; sepsis; vasoactive agentsAcute kidney injury; Critical care; Dialysis; Norepinephrine; Sepsis; Vasoactive agents[SDGs]SDG3noradrenalin; acute kidney failure; adult; aged; APACHE; Article; cohort analysis; comorbidity assessment; continuous renal replacement therapy; creatinine blood level; disease severity; female; fluid resuscitation; geographic distribution; Glasgow coma scale; heart failure; heart output; hemodialysis; hepatorenal syndrome; hospital discharge; human; intensive care unit; international normalized ratio; major clinical study; male; mean arterial pressure; middle aged; mortality rate; observational study; prospective study; renal replacement therapy; respiratory failure; septic shock; Sequential Organ Failure Assessment Score; urea nitrogen blood levelNorepinephrine Administration Is Associated with Higher Mortality in Dialysis Requiring Acute Kidney Injury Patients with Septic Shockjournal article10.3390/jcm7090274302131072-s2.0-85085772111https://api.elsevier.com/content/abstract/scopus_id/85085772111