Norepinephrine shortage led to higher mortality in septic shock patients

Patients with septic shock taking phenylephrine during the 2011 norepinephrine shortage experienced higher in-hospital mortality rates.
Patients with septic shock taking phenylephrine during the 2011 norepinephrine shortage experienced higher in-hospital mortality rates.

Patients with septic shock admitted to hospitals during the 2011 norepinephrine shortage had higher in-hospital mortality compared with patients admitted to hospitals during quarters of normal use, according to a study published in JAMA.

Emily Vail, MD, from the Department of Anesthesiology at Columbia University in New York, and colleagues assessed changes to patient care and outcomes associated with a 2011 national shortage of norepinephrine, the first-line vasopressor for septic shock. The authors conducted a retrospective analysis of administrative and pharmacy billing data captured in the Premier Healthcare Database between July 1, 2008, and June 30, 2013. The study period was divided into quarter years (3-month periods), and the baseline period was defined as the first 8 quarters of data (July 2008 through June 2010).

The primary outcome was in-hospital mortality due to the norepinephrine shortage. Patients were considered exposed to the norepinephrine shortage if they were admitted to a hospital in 2011 during a quarter in which the hospital demonstrated at least a 20% relative decrease in norepinephrine use compared with its baseline rate. The secondary outcome was the use of individual vasopressors.

A total of 27,835 patients from 26 hospitals that demonstrated at least 1 quarter of norepinephrine shortage were included in the study; median age was 69 years and 47% were women. Norepinephrine use among cohort patients declined from 77.0% of patients before the shortage to a low of 55.7% in the second quarter of 2011.

During this time, phenylephrine was the most frequently used alternative vasopressor (baseline, 36.2%; maximum, 54.4%). Hospital admission during quarters of shortage was associated with an increased rate of in-hospital mortality (9283 of 25,874 patients [35.9%] vs 777 of 1961 patients [39.6%], respectively; absolute risk increase, 3.7%).

“The decreased use of norepinephrine during periods of shortage was associated with an increase in use of phenylephrine,” the authors stated. “Receipt of care in a hospital experiencing a norepinephrine shortage was associated with an increased rate of in-hospital mortality.”

Reference

  1. Vail E, Gershengorn HB, Hua M, et al. Association between US norepinephrine shortage and mortality among patients with septic shock. JAMA. 11 April 2017. doi: 10.1001/jama.2017.2841
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