Steroid-Dopamine Combination May Be Fatal in Septic Shock

A new study has found that a combination of steroids and dopamine is associated with an increased 28-day mortality in patients with shock, and in particular those with septic shock.

Researchers at Erasme University Hospital (Brussels, Belgium) performed a secondary analysis of the Sepsis Occurrence in Acutely Ill Patients (SOAP) trial, which was undertaken to determine whether dopamine or norepinephrine were superior as first-line vasopressor agents in restoring and maintaining blood pressure for the treatment of shock. The trial assigned 858 patients with shock to receive dopamine and 821 patients to receive norepinephrine. In the original study, dopamine was associated with a nonsignificant increase in 28-day mortality, compared with norepinephrine; dopamine was also associated with significantly more arrhythmic events.

In search of confounding factors, the researchers went back and looked at the information on prednisolone and hydrocortisone use within 24 hours of randomization to dopamine or norepinephrine; steroid use was not randomized and was left to the discretion of the attending physician. In total, 885 (53.2%) of the SOAP patients received steroids, the most common of which was hydrocortisone (670 patients). The reanalysis found that overall, 28-day mortality tended to be higher in patients receiving steroids than in those not receiving steroids. The 28-day mortality rate was significantly higher in patients receiving steroids plus dopamine than in those receiving steroids plus norepinephrine, although it was similar in patients receiving dopamine or norepinephrine without steroids. The study was presented at the Society of Critical Care Medicine 40th critical care congress, held during January 2011 in San Diego (CA, USA).

"Dopamine should not be used anymore as a vasopressor; period. At least that's my opinion,” said lead author and study presenter Prof. Daniel De Backer, MD, of the department of intensive care. "You have more side effects and you face an increase in mortality rates, so it is of no benefit and is potentially more disadvantageous [and therefore] probably not a good idea to use it.”

Norepinephrine acts mainly in the locus coeruleus area of the brainstem. When released, it has an impact on the "fight-or-flight" response, the body's biological response to stress. In addition, norepinephrine is also involved in pain, cognition, mood, emotions, movement, and blood pressure.

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Erasme University Hospital