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.
|State||Published - May 1 2020|
Bibliographical noteFunding Information:
The authors acknowledge the contributions from all members of the EHR Working Group at the Center for Big Data in Health Sciences CBD-HS. This project is supported by the CBD-HS at the School of Public Health, University of Texas Health Science Center at Houston (UTHealth), and partially supported (support on data preparation) by the SBMI Data Service Office and Data Science and Informatics Core for Cancer Research (funded by CPRIT grant no. RP170668) at UTHealth. Some of the trainees are supported by the NIH training grant no. 2T32GM074902. Because of the sensitive nature of the data collected for this study, requests to access the data from qualified researchers trained in human subject confidentiality protocols may be sent to Hulin Wu at hulin. wu@uth. tmc. edu.
© AANS 2020, except where prohibited by US copyright law.
- Subarachnoid hemorrhage
ASJC Scopus subject areas
- Clinical Neurology