877: Comparative Analysis of Effectiveness of Vasopressor in Septic Shock: Bayesian Network Meta-Analysis

Introduction: Management of septic shock relies on vasopressors; we follow effectiveness of different vasopressor therapies in reducing 28-day mortality and ICU stay duration for patients with septic shock. Methods: We conducted a Bayesian network meta-analysis with 39 randomized controlled trials (RCTs) involving 5,295 patients using PubMed, Embase, and Scopus. The vasopressors compared in the analysis were norepinephrine (reference group), norepinephrine combined with dobutamine, dopexamine, epinephrine, vasopressin, as well as vasopressin, terlipressin, phenylephrine, dopexamine, and dopamine. The outcomes measured 28-day mortality (represented as relative risk RR with a 95% credible interval CrI) and duration of ICU stay in days (measured as mean difference MD with a 95% CrI). A random-effects model was used to account for variability among studies, and Bayesian analysis utilized Markov Chain Monte Carlo methods. The surface under the cumulative ranking curve (SUCRA) was employed to rank the interventions. Results: For 28-day mortality, the combination of norepinephrine and dopexamine ranked the highest (RR 0.47, 95% CrI 0.10-1.53, SUCRA 85.12), followed by norepinephrine combined with dobutamine (RR 0.75, 95% CrI 0.46-1.20, SUCRA 74.20), norepinephrine combined with epinephrine (RR 0.77, 95% CrI 0.38-1.56, SUCRA 64.82), norepinephrine combined with vasopressin (RR 0.86, 95% CrI 0.65-1.13, SUCRA 60.69), vasopressin alone (RR 0.90, 95% CrI 0.80-1.01, SUCRA 56.34), epinephrine alone (RR 0.87, 95% CrI 0.60-1.27, SUCRA 54.76), terlipressin (RR 0.96, 95% CrI 0.79-1.15, SUCRA 42.50), norepinephrine (SUCRA 34.19), phenylephrine (RR 1.04, 95% CrI 0.71-1.51, SUCRA 31.95), dopexamine (RR 1.21, 95% CrI 0.37-4.48, SUCRA 30.67), and dopamine (RR 1.12, 95% CrI 0.99-1.28, SUCRA 14.77). For ICU stay duration, norepinephrine ranked the highest (SUCRA 63.34), followed by terlipressin (MD -0.14, 95% CrI -13.07 to 12.81, SUCRA 60.76), dopamine (MD 0.67, 95% CrI -26.23 to 27.64, SUCRA 53.49), and vasopressin (MD 5.77, 95% CrI -4.26 to 15.76, SUCRA 22.42). Conclusions: Norepinephrine combined with dopexamine and norepinephrine with dobutamine show the greatest potential for reducing 28-day mortality in septic shock. Further large-scale, head-to-head randomized controlled trials are needed to confirm these findings.