Vasopressor treatment and mortality following nontraumatic subarachnoid hemorrhage: a nationwide electronic health record analysis.

Authors

George Williams, University of Texas Health Science Center at Houston, School of Health Information Sciences, Houston TX, USA
Vahed Maroufy
Laila Rasmy
Derek Brown
Duo Yu
Hai Zhu
Yashar Talebi
Xueying Wang
Emy Thomas
Gen Zhu
Ashraf Yaseen
Hongyu Miao
Luis Leon Novelo
Degui Zhi
Stacia M DeSantis
Hongjian Zhu
Jose-Miguel Yamal
David Aguilar
Hulin Wu

Publication Date

5-1-2020

Journal

Neurosurgery Focus

Abstract

OBJECTIVE: Subarachnoid hemorrhage (SAH) is a devastating cerebrovascular condition, not only due to the effect of initial hemorrhage, but also due to the complication of delayed cerebral ischemia (DCI). While hypertension facilitated by vasopressors is often initiated to prevent DCI, which vasopressor is most effective in improving outcomes is not known. The objective of this study was to determine associations between initial vasopressor choice and mortality in patients with nontraumatic SAH.

METHODS: The authors conducted a retrospective cohort study using a large, national electronic medical record data set from 2000-2014 to identify patients with a new diagnosis of nontraumatic SAH (based on ICD-9 codes) who were treated with the vasopressors dopamine, phenylephrine, or norepinephrine. The relationship between the initial choice of vasopressor therapy and the primary outcome, which was defined as in-hospital death or discharge to hospice care, was examined.

RESULTS: In total, 2634 patients were identified with nontraumatic SAH who were treated with a vasopressor. In this cohort, the average age was 56.5 years, 63.9% were female, and 36.5% of patients developed the primary outcome. The incidence of the primary outcome was higher in those initially treated with either norepinephrine (47.6%) or dopamine (50.6%) than with phenylephrine (24.5%). After adjusting for possible confounders using propensity score methods, the adjusted OR of the primary outcome was higher with dopamine (OR 2.19, 95% CI 1.70-2.81) and norepinephrine (OR 2.24, 95% CI 1.80-2.80) compared with phenylephrine. Sensitivity analyses using different variable selection procedures, causal inference models, and machine-learning methods confirmed the main findings.

CONCLUSIONS: In patients with nontraumatic SAH, phenylephrine was significantly associated with reduced mortality in SAH patients compared to dopamine or norepinephrine. Prospective randomized clinical studies are warranted to confirm this finding.

Keywords

Adult, Aged, Dopamine, Electronic Health Records, Female, Glasgow Coma Scale, Hospital Mortality, Humans, Logistic Models, Male, Middle Aged, Norepinephrine, Patient Discharge, Phenylephrine, Retrospective Studies, Subarachnoid Hemorrhage, Vasoconstrictor Agents