TY - JOUR
T1 - Vasopressor treatment and mortality following nontraumatic subarachnoid hemorrhage
T2 - A nationwide electronic health record analysis
AU - Williams, George
AU - Maroufy, Vahed
AU - Rasmy, Laila
AU - Brown, Derek
AU - Yu, Duo
AU - Zhu, Hai
AU - Talebi, Yashar
AU - Wang, Xueying
AU - Thomas, Emy
AU - Zhu, Gen
AU - Yaseen, Ashraf
AU - Miao, Hongyu
AU - Novelo, Luis Leon
AU - Zhi, Degui
AU - DeSantis, Stacia M.
AU - Zhu, Hongjian
AU - Yamal, Jose Miguel
AU - Aguilar, David
AU - Wu, Hulin
N1 - Publisher Copyright:
© AANS 2020, except where prohibited by US copyright law.
PY - 2020/5/1
Y1 - 2020/5/1
N2 - OBJECTIVE Subarachnoid hemorrhage (SAH) is a devastating cerebrovascular condition, not only due to the effect of initial hemorrhage, but also due to the complication of delayed cerebral ischemia (DCI). While hypertension facilitated by vasopressors is often initiated to prevent DCI, which vasopressor is most effective in improving outcomes is not known. The objective of this study was to determine associations between initial vasopressor choice and mortality in patients with nontraumatic SAH. METHODS The authors conducted a retrospective cohort study using a large, national electronic medical record data set from 2000-2014 to identify patients with a new diagnosis of nontraumatic SAH (based on ICD-9 codes) who were treated with the vasopressors dopamine, phenylephrine, or norepinephrine. The relationship between the initial choice of vasopressor therapy and the primary outcome, which was defined as in-hospital death or discharge to hospice care, was examined. RESULTS In total, 2634 patients were identified with nontraumatic SAH who were treated with a vasopressor. In this cohort, the average age was 56.5 years, 63.9% were female, and 36.5% of patients developed the primary outcome. The incidence of the primary outcome was higher in those initially treated with either norepinephrine (47.6%) or dopamine (50.6%) than with phenylephrine (24.5%). After adjusting for possible confounders using propensity score methods, the adjusted OR of the primary outcome was higher with dopamine (OR 2.19, 95% CI 1.70-2.81) and norepinephrine (OR 2.24, 95% CI 1.80-2.80) compared with phenylephrine. Sensitivity analyses using different variable selection procedures, causal inference models, and machine-learning methods confirmed the main findings. CONCLUSIONS In patients with nontraumatic SAH, phenylephrine was significantly associated with reduced mortality in SAH patients compared to dopamine or norepinephrine. Prospective randomized clinical studies are warranted to confirm this finding.
AB - OBJECTIVE Subarachnoid hemorrhage (SAH) is a devastating cerebrovascular condition, not only due to the effect of initial hemorrhage, but also due to the complication of delayed cerebral ischemia (DCI). While hypertension facilitated by vasopressors is often initiated to prevent DCI, which vasopressor is most effective in improving outcomes is not known. The objective of this study was to determine associations between initial vasopressor choice and mortality in patients with nontraumatic SAH. METHODS The authors conducted a retrospective cohort study using a large, national electronic medical record data set from 2000-2014 to identify patients with a new diagnosis of nontraumatic SAH (based on ICD-9 codes) who were treated with the vasopressors dopamine, phenylephrine, or norepinephrine. The relationship between the initial choice of vasopressor therapy and the primary outcome, which was defined as in-hospital death or discharge to hospice care, was examined. RESULTS In total, 2634 patients were identified with nontraumatic SAH who were treated with a vasopressor. In this cohort, the average age was 56.5 years, 63.9% were female, and 36.5% of patients developed the primary outcome. The incidence of the primary outcome was higher in those initially treated with either norepinephrine (47.6%) or dopamine (50.6%) than with phenylephrine (24.5%). After adjusting for possible confounders using propensity score methods, the adjusted OR of the primary outcome was higher with dopamine (OR 2.19, 95% CI 1.70-2.81) and norepinephrine (OR 2.24, 95% CI 1.80-2.80) compared with phenylephrine. Sensitivity analyses using different variable selection procedures, causal inference models, and machine-learning methods confirmed the main findings. CONCLUSIONS In patients with nontraumatic SAH, phenylephrine was significantly associated with reduced mortality in SAH patients compared to dopamine or norepinephrine. Prospective randomized clinical studies are warranted to confirm this finding.
KW - Dopamine
KW - Mortality
KW - Norepinephrine
KW - Phenylephrine
KW - Subarachnoid hemorrhage
KW - Vasopressors
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U2 - 10.3171/2020.2.FOCUS191002
DO - 10.3171/2020.2.FOCUS191002
M3 - Article
C2 - 32357322
AN - SCOPUS:85084930458
SN - 1092-0684
VL - 48
JO - Neurosurgical Focus
JF - Neurosurgical Focus
IS - 5
M1 - 1002
ER -