{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T13:20:19Z","timestamp":1790601619834,"version":"4.1.0"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,9,21]],"date-time":"2021-09-21T00:00:00Z","timestamp":1632182400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p><jats:bold>Purpose:<\/jats:bold> To determine whether inotrope administration is associated with increased all-cause mortality in cardiogenic shock (CS) patients and to identify inotropes superior for improving mortality.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> This retrospective cohort study analyzed data retrieved from the Philips Electronic ICU (eICU) database, a clinical database of 200,859 patients from over 208 hospitals located throughout the United States. The database was searched for patients admitted with CS to the intensive care unit (ICU) between 2014 and 2015. We evaluated 34,381 CS patients. They were classified into the inotrope and non-inotrope groups based on whether inotropes were administered during hospitalization. The primary endpoint was all-cause hospital mortality.<\/jats:p><jats:p><jats:bold>Findings:<\/jats:bold> In total, 15,021 (43.69%) patients received inotropes during hospitalization. The in-hospital mortality rate was significantly higher in the inotrope group than in the non-inotrope group (2,999 [24.03%] vs. 1,547 [12.40%], adjusted hazard ratio: 2.24; 95% confidence interval [CI]: 2.09\u20132.39; <jats:italic>p<\/jats:italic> &amp;lt; 0.0001). After propensity score matching according to the cardiac index, 359 patients were included in each group. The risk of ICU (OR 5.65, 95% CI, 3.17\u201310.08, <jats:italic>p<\/jats:italic> &amp;lt; 0.001) and hospital (OR 2.63, 95% CI: 1.75\u20133.95, <jats:italic>p<\/jats:italic> &amp;lt; 0.001) mortality in the inotrope group was significantly higher. In the inotrope group, the administration of norepinephrine \u22640.1 \u03bcg\/kg\/min and dopamine \u226415 \u03bcg\/kg\/min did not increase the risk of hospital mortality, and milrinone administration was associated with a lower mortality risk (odds ratio: 0.559, 95% CI: 0.430\u20130.727, <jats:italic>p<\/jats:italic> &amp;lt; 0.001). Meanwhile, the administration of &amp;gt;0.1 \u03bcg\/kg\/min dobutamine, epinephrine, and norepinephrine and dopamine &amp;gt;15 \u03bcg\/kg\/min was associated with a higher risk of hospital mortality.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> Inotropes should be used cautiously because they may be associated with a higher risk of mortality in CS patients. Low-dose norepinephrine and milrinone may associated with lower risk of hospital mortality in these patients, and supportive therapies should be considered when high-dose inotropes are administered.<\/jats:p>","DOI":"10.3389\/fcvm.2021.696138","type":"journal-article","created":{"date-parts":[[2021,9,21]],"date-time":"2021-09-21T04:41:18Z","timestamp":1632199278000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":31,"title":["Inotrope Use and Intensive Care Unit Mortality in Patients With Cardiogenic Shock: An Analysis of a Large Electronic Intensive Care Unit Database"],"prefix":"10.3389","volume":"8","author":[{"given":"Fei","family":"Gao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,9,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1016\/j.hfc.2019.12.005","article-title":"Contemporary management of acute decompensated heart failure and cardiogenic shock","volume":"16","author":"Kitai","year":"2020","journal-title":"Heart Fail Clin"},{"key":"B2","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1016\/j.ahj.2006.09.005","article-title":"Use and impact of inotropes and vasodilator therapy in hospitalized patients with severe heart failure","volume":"153","author":"Elkayam","year":"2007","journal-title":"Am Heart J"},{"key":"B3","doi-asserted-by":"publisher","first-page":"47G","DOI":"10.1016\/j.amjcard.2005.07.021","article-title":"Reassessment of dobutamine, dopamine, and milrinone in the management of acute heart failure syndromes","volume":"96","author":"Bayram","year":"2005","journal-title":"Am J Cardiol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1541","DOI":"10.1001\/jama.287.12.1541","article-title":"Short-term intravenous milrinone for acute exacerbation of chronic heart failure: a randomized controlled trial.","volume":"287","author":"Cuffe","year":"2002","journal-title":"JAMA"},{"key":"B5","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1056\/NEJMoa0907118","article-title":"Comparison of dopamine and norepinephrine in the treatment of shock","volume":"362","author":"De Backer","year":"2010","journal-title":"N Engl J Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1097\/SHK.0000000000001390","article-title":"Temporal trends and clinical outcomes associated with vasopressor and inotrope use in the cardiac intensive care unit","volume":"53","author":"Jentzer","year":"2020","journal-title":"Shock"},{"key":"B7","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1186\/s13613-015-0052-1","article-title":"Experts' recommendations for the management of adult patients with cardiogenic shock","volume":"5","author":"Levy","year":"2015","journal-title":"Ann Intensive Care"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1347","DOI":"10.1111\/aas.12780","article-title":"Scandinavian SSAI clinical practice guideline on choice of first-line vasopressor for patients with acute circulatory failure","volume":"60","author":"M\u00f8ller","year":"2016","journal-title":"Acta Anaesthesiol Scand"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e232","DOI":"10.1161\/CIR.0000000000000525","article-title":"Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association","volume":"136","author":"van Diepen","year":"2017","journal-title":"Circulation"},{"key":"B10","doi-asserted-by":"publisher","first-page":"CD009669","DOI":"10.1002\/14651858.CD009669.pub3","article-title":"Inotropic agents and vasodilator strategies for the treatment of cardiogenic shock or low cardiac output syndrome","volume":"1","author":"Schumann","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"B11","doi-asserted-by":"publisher","first-page":"CD003709","DOI":"10.1002\/14651858.CD003709.pub4","article-title":"Vasopressors for hypotensive shock","volume":"2","author":"Gamper","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"B12","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/j.jacc.2005.03.051","article-title":"In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medications: an analysis from the Acute Decompensated Heart Failure National Registry (ADHERE)","volume":"46","author":"Abraham","year":"2005","journal-title":"J Am Coll Cardiol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1016\/j.cardfail.2014.05.006","article-title":"Inotrope use and outcomes among patients hospitalized for heart failure: impact of systolic blood pressure, cardiac index, and etiology","volume":"20","author":"Kalogeropoulos","year":"2014","journal-title":"J Card Fail"},{"key":"B14","doi-asserted-by":"publisher","first-page":"766","DOI":"10.1007\/s00268-013-1926-8","article-title":"Catecholamine dosing and survival in adult intensive care unit patients","volume":"37","author":"Kastrup","year":"2013","journal-title":"World J Surg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"680","DOI":"10.1016\/j.ahj.2009.08.005","article-title":"Predictors of 30-day mortality in patients with refractory cardiogenic shock following acute myocardial infarction despite a patent infarct artery","volume":"158","author":"Katz","year":"2009","journal-title":"Am Heart J"},{"key":"B16","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1016\/j.athoracsur.2016.10.023","article-title":"Venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock in elderly patients: trends in application and outcome from the Extracorporeal Life Support Organization (ELSO) registry","volume":"104","author":"Lorusso","year":"2017","journal-title":"Ann Thorac Surg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1186\/s13054-016-1387-1","article-title":"Current real-life use of vasopressors and inotropes in cardiogenic shock - adrenaline use is associated with excess organ injury and mortality","volume":"20","author":"Tarvasm\u00e4ki","year":"2016","journal-title":"Crit Care"},{"key":"B18","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1016\/S0140-6736(07)61344-0","article-title":"Norepinephrine plus dobutamine versus epinephrine alone for management of septic shock: a randomised trial","volume":"370","author":"Annane","year":"2007","journal-title":"Lancet"},{"key":"B19","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1007\/s00134-018-5222-9","article-title":"Epinephrine and short-term survival in cardiogenic shock: an individual data meta-analysis of 2583 patients","volume":"44","author":"L\u00e9opold","year":"2018","journal-title":"Intensive Care Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1016\/j.jacc.2018.04.051","article-title":"Epinephrine versus norepinephrine for cardiogenic shock after acute myocardial infarction","volume":"72","author":"Levy","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1097\/MCC.0000000000000632","article-title":"Inotropes and vasopressors use in cardiogenic shock: when, which and how much","volume":"25","author":"Levy","year":"2019","journal-title":"Curr Opin Crit Care"},{"key":"B22","doi-asserted-by":"publisher","first-page":"2069","DOI":"10.1016\/j.jacc.2014.01.016","article-title":"Inotropes","volume":"63","author":"Francis","year":"2014","journal-title":"J Am Coll Cardiol"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2021.696138\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,21]],"date-time":"2021-09-21T04:41:20Z","timestamp":1632199280000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2021.696138\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,21]]},"references-count":22,"alternative-id":["10.3389\/fcvm.2021.696138"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2021.696138","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,21]]},"article-number":"696138"}}