Supplemental Figures and Tables
Outcomes Associated with Norepinephrine Use among Cardiac Intensive Care Unit Patients with Shock
Barry Burstein MD
1, Saraschandra Vallabhajosyula MBBS
1,2,Bradley Ternus MD
2, Gregory W. Barsness MD
2, Kianoush Kashani MD MS
1,3, Jacob C. Jentzer, MD
1,21
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
2
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
3
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States
Supplemental Figure 1
Supplemental Figure 2
Supplemental Figure 3
Supplemental Table 1a
Supplemental Table 1b
Supplemental Table 2
Supplemental Figure 1: Patient flow diagram describing inclusion/exclusion criteria and patient groups.
Supplemental Figure 2: CICU and hospital mortality as a function of the highest CVI score for any individual vasopressor
0%
5%
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15%
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25%
30%
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45%
1 2 3 4
CICU mortality Hospital mortality
Supplemental Figure 3: Hospital and CICU mortality, by vasopressor type and dose
Supplemental Table 1a: Comparison of vasopressor doses in Norepinephrine Equivalents
Drug Dose Norepinephrine Equivalent (NEE)
Epinephrine 0.1 g/kg/min 0.1 g/kg/min
Dopamine 15 g/kg/min 0.1 g/kg/min
Norepinephrine 0.1 g/kg/min 0.1 g/kg/min
Phenylephrine 1 g/kg/min 0.1 g/kg/min
Vasopressin 0.04 units/min 0.1 g/kg/min
Supplemental Table 1b: Cumulative Vasopressor Index
Drug CVI = 1 CVI = 2 CVI = 3 CVI = 4
Dopamine (g/kg/min) Dose 5 5 < dose 10 10 < dose 15 Dose > 15
Epinephrine (g/kg/min) --- 0 < dose < 0.05 0.05 < dose < 0.1 > 0.1
Norepinephrine (g/kg/min) --- 0 < dose < 0.05 0.05 < dose < 0.1 > 0.1
Phenylephrine (g/kg/min) --- 0 < dose < 0.4 0.4 < dose < 0.8 > 0.8
Vasopressin (units/min) --- --- < 0.4 ≥ 0.4
Supplemental Table 2: Characteristics of patients who received norepinephrine compared to those without norepinephrine
Norepinephrine No norepinephrine P Value
No. available No. available
Age (years) 715 67.6 ± 14.9 1375 67.9 ± 14.1 0.84
Female sex (n, %) 715 256 (35.8) 1375 507 (36.9) 0.63
White race (n, %) 715 638 (89.2) 1375 1244 (90.5) 0.81
Discharge Diagnosis (n, %)
Acute coronary syndrome 714 291 (40.8) 1373 561 (40.9) 0.94
Cardiac arrest 714 194 (27.2) 1373 245 (17.8) < 0.01
Cardiogenic shock 714 317 (44.4) 1373 308 (22.4) < 0.01
Congestive heart failure 714 413 (57.8) 1373 705 (51.4) < 0.01
Shock 714 413 (57.8) 1373 363 (26.4) < 0.01
Sepsis 714 230 (32.2) 1373 137 (10.0) < 0.01
Charlson Comorbidity Index 712 2.54 ± 2.6 1371 2.71 ± 2.8 0.39
BMI, kg/m2 709 30.4 ± 7.8 1358 29.5 ± 6.9 0.01
CICU LOS, days 715 4.5 ± 5.3 1375 4.1 ± 10.5 < 0.01
Hospital LOS, days 715 14.0 ± 18.7 1375 12.1 ± 18.0 < 0.01
Invasive ventilator use (n, %) 715 501 (70.1) 1375 543 (39.5) < 0.01
Non-invasive ventilator use (n, %) 715 198 (27.7) 1375 245 (17.8) < 0.01
APACHE III 715 93.0 ± 33.5 1375 76.2 ± 29.0 < 0.01
Maximum week 1 SOFA score 714 10.3 ± 3.7 1371 6.7 ± 3.7 < 0.01
Mean week 1 SOFA score 714 7.8 ± 3.6 1370 4.9 ± 3.0 < 0.01
Peak norepinephrine equivalents (NEE, mcg/kg/min)
715 0.50 ± 0.7 1375 0.14 ± 0.3 < 0.01
Peak Cumulative Vasopressor Index (CVI) 715 7.4 ± 3.8 1375 3.4 ± 2.6 < 0.01
High-dose vasopressors (n, %) 715 523 (73.2) 1375 402 (29.2) < 0.01
Number of vasoactive infusions (first 24h) 715 2.6 ± 1.6 1375 1.6 ± 0.8 < 0.01
Dobutamine use (n, %) 715 135 (18.9) 1375 147 (10.7) < 0.01
Dopamine use (n, %) 715 306 (42.8) 1375 896 (65.2) < 0.01
Epinephrine use (n, %) 715 220 (30.8) 1375 419 (30.5) 0.89
Milrinone use (n, %) 715 92 (12.9) 1375 227 (16.5) 0.03
Phenylephrine use (n, %) 715 86 (12.0) 1375 277 (20.2) < 0.01
Vasopressin use (n, %) 715 291 (40.7) 1375 266 (19.4) < 0.01
Maximum lactate (mmol/L) 547 4.4 ± 4.1 522 3.6 ± 3.7 < 0.01
Blood transfusion in CICU (n, %) 715 223 (31.2) 1375 327 (23.8) < 0.01
Percutaneous coronary intervention (n, %) 715 182 (25.4) 1375 388 (28.2) 0.18
Pulmonary artery catheter use (n, %) 715 159 (22.2) 1375 226 (16.4) < 0.01
Intra-aortic balloon pump use (n, %) 715 179 (25.0) 1375 346 (25.2) 0.95
Dialysis initiated during CICU stay (n, %) 715 96 (13.4) 1375 82 (6.0) < 0.01
CICU mortality (n, %) 715 207 (29.0) 1375 228 (16.6) < 0.01
Hospital mortality (n, %) 715 282 (39.4) 1375 296 (21.5) < 0.01
BMI, body mass index; CICU, cardiac intensive care unit; LOS, length of stay
