Supplementary Online Content
De Backer D, Aldecoa C, Njimi H, Vincent JL.
DOPAMINE VERSUS NOREPINEPHRINE IN THE TREATMENT OF SEPTIC
SHOCK: A METAANALYSIS.
A/ Search strategy (Pubmed):
1. agents, dopaminergic [MeSH Terms] AND outcome
2. norepinephrine [MeSH terms] AND outcome
3. agents, dopaminergic [MeSH Terms] AND mortality
4. norepinephrine [MeSH terms] AND mortality
5. agents, dopaminergic [MeSH Terms] AND sepsis
6. norepinephrine [MeSH terms] AND sepsis
7. agents, dopaminergic [MeSH Terms] AND shock
8. norepinephrine [MeSH terms] AND shock
9. vasopressor agents AND mortality
9. vasopressor agents and outcome
10. dopamine AND outcome
11. noradrenaline AND outcome
12. dopamine AND mortality
13. noradrenaline AND mortality
B/ Evaluation of risk of death (28 day or nearest estimate) in whole populations in observational
and interventional trials.
The 5 observational trials included a total of 1952 patients, of whom 763 were allocated to
receive dopamine and 1189 norepinephrine. There was significant heterogeneity among trials
(P<0.001, I² 85 [68-93]%). The aggregate relative risk of death with dopamine use did not differ
significantly from the risk associated with norepinephrine use (RR 1.13 [0.85-1.48], p=0.40).
The 6 interventional trials included a total of 2039 patients, of whom 1045 were allocated to
receive dopamine and 994 norepinephrine. There was no significant heterogeneity among trials
(P=0.75, I² 0 [0-22]%). The aggregate relative risk of death with dopamine use was significantly
higher than with norepinephrine use (RR 1.10 [1.01-1.20], p=0.026).
Electronic figures legend:
eFigure 1. Funnel plot of risk ratio of death in observational studies.
This figure identifies one study (Povoa et al (1) on left upper part) as an outlier
eFigure 2. Forest plot of risk ratio (RR) of death (28 day or nearest estimate) in observational
trials after exclusion of the trial by Povoa et al (1).
P value for aggregate RR of dopamine compared to norepinephrine was 0.008. Relative weights
of the different trials in the analysis: Martin et al (2) 26%, Hall et al (3) 19%, Sakr et al (4) 35%,
Boulain et al (5) 21%. There was no significant heterogeneity among the trials (P=0.22, I² 32.3
[0.0-75.9]%).
eFigure 3. Funnel plot of risk ratio of death in interventional studies.
eFigure 4: Forest plot from the interventional trials of risk ratio (RR) of developing arrhythmias.
P value for aggregate RR of dopamine compared to norepinephrine was 0.001.
Reference List
1. Povoa PR, Carneiro AH, Ribeiro OS, et al.: Influence of vasopressor agent in septic shock mortality.
Results from the Portuguese Community-Acquired Sepsis Study (SACiUCI study). Crit Care
Med 2009;37: 410-416
2. Martin C, Viviand X, Leone M, et al.: Effect of norepinephrine on the outcome of septic shock. Crit
Care Med 2000;28: 2758-2765
3. Hall LG, Oyen LJ, Taner CB, et al.: Fixed-dose vasopressin compared with titrated dopamine and
norepinephrine as initial vasopressor therapy for septic shock. Pharmacotherapy 2004;24:
1002-1012
4. Sakr Y, Reinhart K, Vincent JL, et al.: Does dopamine administration in shock influence outcome?
Results of the Sepsis Occurrence in Acutely Ill Patients (SOAP) Study. Crit Care Med
2006;34: 589-597
5. Boulain T, Runge I, Bercault N, et al.: Dopamine therapy in septic shock: Detrimental effect on
survival? J Crit Care 2009;24: 575-582
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