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Published on: February 10, 2013
The effect of dobutamine vs milrinone in sepsis: A big data, real-world study
Youfeng Zhu1, Haiyan Yin2, Rui Zhang1
1Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China.
Background:
The use of dobutamine in patients with sepsis is questionable. Some studies reported milrinone was used as an alternative inotropic agent. We aim to evaluate whether milrinone is better than dobutamine in patients with sepsis.
Methods:
Based on the analysis of MIMIC III public database, we performed a big data, real-world study. According to the use of dobutamine or milrinone, patients were categorised as the dobutamine group or milrinone group. We used propensity score matched (PSM) analysis to adjust for confoundings. The primary outcome was hospital mortality.
Results:
In this study, after screening 38 605 patients, 235 patients with sepsis were included. One hundred and eighty-three patients were in the dobutamine group and 52 patients were in the milrinone group. For the primary outcome of hospital mortality, there was no significant between-group difference (73/183 in dobutamine group vs 23/52 in milrinone group, OR 0.84, 95% CI 0.45-1.56; P = .574). After adjusting for confoundings between groups by PSM analysis, hospital mortality was consistent with the overall result (50% vs 41.3%, OR 1.42, 95% CI 0.68-2.97; P = .349). For the secondary outcomes, more patients in milrinone group received RRT use (46.2% vs 22.4%, P = .001), had longer length of ICU stay (20.97 ± 22.84 days vs 11.10 ± 11.54 days, P = .004) and hospital stay (26.14 ± 25.13 days vs 14.51 ± 13.11 days, P = .002) than those in dobutamine group.
Conclusions:
Compared with dobutamine, the use of milrinone did not decrease hospital mortality in patients with sepsis. Furthermore, milrinone was associated with more RRT therapy, longer length of ICU stay and hospital stay than dobutamine.
Insights
Milrinone did not improve hospital survival in sepsis patients compared to dobutamine. Milrinone use was linked to increased need for renal replacement therapy (RRT) and longer ICU and hospital stays.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Health Services Research
Background:
- Dobutamine use in sepsis is debated.
- Milrinone is an alternative inotropic agent.
- Evidence comparing milrinone and dobutamine in sepsis is limited.
Purpose of the Study:
- To compare the efficacy of milrinone versus dobutamine in sepsis patients.
- To evaluate the impact on hospital mortality and secondary outcomes.
Main Methods:
- Real-world study using the MIMIC III database.
- Propensity score matching (PSM) to control for confounders.
- Analysis of hospital mortality as the primary outcome.
Main Results:
- No significant difference in hospital mortality between milrinone and dobutamine groups (OR 0.84, P=.574).
- PSM analysis confirmed no significant difference in mortality (OR 1.42, P=.349).
- Milrinone group showed higher rates of renal replacement therapy (RRT) and longer ICU/hospital stays.
Conclusions:
- Milrinone does not reduce hospital mortality in sepsis patients compared to dobutamine.
- Milrinone is associated with increased RRT use and prolonged hospitalizations.
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