Effects of adjunctive dobutamine on outcomes among patients with septic shock: a propensity score matching analysis

Abstract

Background/Aims: Despite some evidence supporting its utility, the role of adjunctive dobutamine in the management of septic shock remains unclear. Methods: The nationwide prospective sepsis cohort of the Korean Sepsis Alliance was analyzed. Adult patients with septic shock receiving norepinephrine were enrolled over a 29-month period. Patients given a dobutamine infusion within 3 days of intensive care unit (ICU) admission were compared with patients who received no infusion. To balance baseline characteristics, propensity score matching (PSM) was used. Results: Of 11,981 patients with sepsis, 1,827 patients with septic shock receiving norepinephrine were included (108 dobutamine vs. 1,719 no dobutamine; mean age 71.4 ± 13.2 years, 59.4% male). After PSM (ratio of 1:2; 105 dobutamine patients and 209 no-dobutamine patients), Sequential Organ Failure Assessment scores and lactate levels on ICU day 3 did not significantly differ between groups. Additionally, in-hospital and ICU mortality rates did not differ between groups (54.3% vs. 48.3%, p = 0.319; 46.7% vs. 39.2%, p = 0.208, respectively). A Cox proportional model revealed that dobutamine use was not associated with in-hospital mortality (HR 1.13, 95% CI 0.81–1.58). However, subgroup analysis indicated that dobutamine use was associated with an increased risk of in-hospital mortality among patients in the lowest quintile of early fluid balance (p = 0.0286 for interaction). Conclusions: Adjunctive dobutamine administration did not improve short-term organ function or hospital outcomes in septic shock patients. However, early fluid balance may influence the impact of dobutamine, highlighting the importance of a more tailored approach.