Risk Management and Healthcare Policy (Jun 2023)
Effect of Early versus Delayed Use of Norepinephrine on Short-Term Outcomes in Patients with Traumatic Hemorrhagic Shock: A Propensity Score Matching Analysis
Abstract
Bing Zhang,1,* Xue Dong,2,* Jia Wang,2 Gong-Ke Li,1 Yong Li,3 Xian-Yao Wan2 1Department of Emergency Intensive Care Medicine, Affiliated Hospital of Yangzhou University, Yangzhou, 225000, People’s Republic of China; 2Department of Critical Care Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, 116000, People’s Republic of China; 3Department of Critical Care Medicine, Affiliated Hospital of Yangzhou University, Yangzhou, 225000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xian-Yao Wan, Department of Critical Care Medicine, The First Affiliated Hospital of Dalian Medical University, No. 193 Joint Road, Sha He Kou District, Dalian, 116000, People’s Republic of China, Tel +86 41183635963, Fax +86 41183635025, Email [email protected] Yong Li, Department of Critical Care Medicine, Affiliated Hospital of Yangzhou University, No. 368 Hanjiang Middle Road, Hanjiang District, Yangzhou, 225000, People’s Republic of China, Tel/Fax +86 51482981199, Email [email protected]: Guidelines recommend norepinephrine (NE) for the treatment of fatal hypotension caused by trauma. However, the optimal timing of treatment remains unclear.Objective: We aimed to investigate the effect of early versus delayed use of NE on survival in patients with traumatic haemorrhagic shock (HS).Materials and Methods: From March 2017 to April 2021, 356 patients with HS in the Department of Emergency Intensive Care Medicine of the Affiliated Hospital of Yangzhou University were identified using the emergency information system and inpatient electronic medical records for inclusion in the study. Our study endpoint was 24 h mortality. We used a propensity score matching (PSM) analysis to reduce bias between groups. Survival models were used to evaluate the relationship between early NE and 24 h survival.Results: After PSM, 308 patients were divided equally into an early NE (eNE) group and a delayed NE (dNE) group. Patients in the eNE group had lower 24 h mortality rates than those in the dNE group (29.9% versus 44.8%, respectively). A receiver operating characteristic analysis demonstrated that a cut-off point for NE use of 4.4 h yielded optimal predictive value for 24 h mortality, with a sensitivity of 95.52%, a specificity of 81.33% and an area under the curve value of 0.9272. Univariate and multivariate survival analyses showed that the survival rate of patients in the eNE group was higher (p < 0.01) than those in the dNE group.Conclusion: The use of NE within the first 3 h was associated with a higher 24 h survival rate. The use of eNE appears to be a safe intervention that benefits patients with traumatic HS.Keywords: norepinephrine, traumatic haemorrhagic shock, propensity score matching
