Effectiveness and Safety of Norepinephrine versus Vasopressin for Septic Shock: A Meta-analysis

Objective To compare the effect of norepinephrine and vasopressin on the hemodynamics and mortality in patients with septic shock.Methods Randomized clinical trials(RCTs) of septic shock treated with norepinephrine in comparison with vasopressin were selected from PubMed,Embase,the Cochrane Library,CBM and CNKI databases.Meta-analysis was conducted by using Review Manager 5.0 software.The results were expressed as risk ratio(RR) for dichotomous outcomes or standardized mean difference(SMD) for continuous data with 95% confidence intervals(CI),and P 0.05 was considered to be significant.Results Five trials(n = 1799) met inclusion criteria.Overall,mortality in these five trials was 36.4%(654 /1799).The mortality of patients treated with norepinephrine was 37.5%(329 /878),while it was 35.3%(325 /921) in those treated with vasopressin.There was no significant difference in mortalities between these two groups(P = 0.36).In addition,there were no significant differences in heart rate(P = 0.63),mean arterial pressure(SMD 0.11; 95% CI,- 0.43,0.66; P = 0.68),cardiac index(P = 0.73),systemic vascular resistance index(P =0.58),oxygen delivery(P = 0.82),oxygen consumption(P = 0.91),and lactic acid(P = 0.38) between the two groups treated either norepinephrine or vasopressin.Conclusions There is no evidence to support that norepinephrine is superior to vasopressin in improving hemodynamics and reducing the mortality in patients with septic shock.