Vasopressin and its analog terlipressin versus norepinephrine in the treatment of septic shock: A meta-analysis

Abstract

Purpose: To compare the effectiveness and safety of vasopressin and its analog terlipressin with norepinephrine treatment in adult patients with septic shock and to explore the most effective and safe protocol. Materials and Methods: This study was based on Cochrane methodology for conducting meta-analysis. Only randomized controlled trials were eligible for this study. The participants were adults who had septic shock. The Review Manager Database (RevMan version 5.1, The Cochrane Collaboration 2011) was used to analyze selected studies. Results: Eleven randomized controlled trial involving 2273 patients were included. The mortality rate was significantly lower in the vasopressin/terlipressin group (relative risk 0.87). The pulmonary artery occlusion pressure was higher in the vasopressin/terlipressin group (mean difference 1.51, 95% CI 0.84 to 2.17). Subgroup analysis showed the mortality rate, heart rate and cardiac index were significantly lower in the vasopressin group compared with the norepinephrine group. Conclusions: Compared with norepinephrine, vasopressin and its analog terlipressin could significantly reduce mortality rate of adult septic shock patients. The combination of low-dose vasopressin and corticosteroids was associated with decreased mortality, heart rate and cardiac index compared with conjoint use of norepinephrine and corticosteroids.