METHODS: We conducted this study of literatures published from the inception to April 30, 2020, using PubMed, Embase, and the Cochrane Library databases without language restriction. Randomized controlled trials comparing NE with non-
catecholamine vasopressors among adult
septic shock patients were included in this meta-analysis. Pooled effects of relative risk (RR) or standard mean difference (SMD) and corresponding 95% confidence interval (CI) were calculated using a random-effects model.
RESULTS: Twenty-three studies covering 4380 participants were finally enrolled. The combined analysis of non-
catecholamine vasopressors resulted in a nonsignificant reduction in 90-day/ICU/hospital mortality except for a decreased in 28-day mortality (n = 4217; RR, 0.92; 95% CI 0.86-0.99; P = 0.02). This favorable result was subsequently verified by the subgroup analyses of low risk of bias studies (RR = 0.91, 95% CI = 0.84 to 0.98; P = 0.02) and
catecholamine-resistant refractory
shock patients group (RR, 0.84; 95% CI = 0.70-1.00; P = 0.048). The pooled analysis of non-
catecholamine vasopressors showed a 14% higher success rate of
shock reversal at 6 h, a 29% decreased risk of
continuous renal replacement therapy, but a 51% increased risk of
hyponatremia and a 2.43 times higher risk of digital
ischemia. Besides, the pooled data showed that non-
catecholamine vasopressors decreased heart rate (HR) (SMD, - 0.43; 95% CI - 0.66 - - 0.19; P < 0.001), serum
creatinine (- 0.15; 95% CI - 0.29 - - 0.01; P = 0.04), and the length of
mechanical ventilation (MV) (- 0.19; 95% CI - 0.31 - - 0.07; P < 0.01, but there was no significant difference in other parameters.
CONCLUSIONS: Current pooled results suggest that the addition of NE to non-
catecholamine vasopressors was associated with a marginally significant reduction in 28-day mortality. Moreover, they were able to shorten the length of MV, improved renal function, decreased HR, and increased the 6-h
shock reversal success rate at the expense of increased the risk of
hyponatremia and digital
ischemia.