Use and clinical outcomes of vasopressors and inotropes among patients admitted at Moi Teaching and Referral Hospital -Eldoret

Abstract

Background: Inotropes and vasopressors are administered to offer hemodynamic support to patients in shock, as a temporary measure to allow for correction of the underlying disease. Inotropes increase cardiac output while vasopressors increase total peripheral resistance leading to a rise in mean arterial pressure (MAP) and perfusion. Despite the high mortality observed among patients started on vasoactive drugs, there is limited data on their use and outcomes in low-income setting and influence of comorbidities. This study aims to document the outcomes of patients started on vasoactive drugs. Objectives: To describe the clinical outcomes of patients started on inotropes and/or vasopressors at MTRH, Eldoret. Methods: This was a prospective observational hospital-based census study that recruited patients who were admitted at the Coronary Care Unit (CCU) in MTRH between December 2018 and June 2019 and received inotropes and/or vasopressors. Data on age, gender, length of stay, medication history, laboratory findings and diagnosis were collected. Patients were followed until discharge from CCU and data on outcomes collected. Sociodemographic and clinical characteristics were analyzed using descriptive statistics. Fischer‘s exact test was used to determine association between outcomes and the various agents and their combinations used. Multinomial regression was used to determine effect of mean arterial pressure on outcomes. p < 0.05 was considered significant Results: 68 patients with a mean age of 51.1 (SD 23.9) years were recruited. Most were female patients (57.3%), who had been admitted in cardiogenic shock (75.7%) due to acute decompensated heart failure (72.5%), with rheumatic heart disease as the main comorbidity (18.2%). Mean baseline MAP was 61.8 mmHg while systolic and diastolic blood pressure was 82 mmHg and 52 mmHg respectively. Most patients (52.9%) received dobutamine as the first agent. A second agent, norepinephrine, dobutamine or milrinone, was administered to 28 (41.2%) patients who had not initially responded adequately. Characteristics of participants who received various agents were similar. The mean arterial pressure in patients treated with one inotrope was significantly higher than in patients who were treated with at least two inotropes (p < 0.001). Thirty-seven (54.4 %) patients died, 9(13.2 %) were discharged to the wards and 22(32.4 %) were discharged home. There was no significant association between outcomes and the initial agent administered (p= 0.807) or the various combinations (p=0.334). Patients with an elevated mean arterial pressure after inotrope treatment were more likely to be discharged to the wards (OR 1.3 [95% CI 1.1-1.6, p=0.001]) or discharged home (OR 1.2 [95% CI 1.1-1. 3, p=0.002]) than to die. Conclusion: Patients with higher MAPs after inotrope/vasopressor administration had better clinical outcomes compared to those with lower MAPs. There was no significant association between the type of inotrope/vasopressor and outcomes. Additionally, there was no significant difference between the use of either one or two inotropes/vasopressors. Recommendations: Further studies with bigger sample sizes need to be conducted to further explore the findings of this study.