SynthesisCritical care (London, England)2025
Association of noradrenaline dose with mortality in critically ill patients: a systematic review and dose-response meta-analysis.
Synthesis in Critical care (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Persistent tissue hypoperfusion improves risk stratification beyond vasopressor dose in refractory septic shock: a secondary analysis of the ANDROMEDA-SHOCK-2 trial.Intensive care medicine · 2026Trial
- [Vasopressors in septic shock: the old and the new].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2026Review
- Alarm configuration and adherence to prescribed mean arterial pressure targets in the intensive care unit: A multicentre pre-post evaluation.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2026Article
- The usual suspects: a pragmatic framework to identify and address reversible contributors in apparent refractory septic shock.Critical care (London, England) · 2026Review
- Mean arterial pressure-to-norepinephrine-equivalent dose ratio, rather than achieved mean arterial pressure alone, is associated with mortality in septic shock.Journal of intensive care · 2026Article
- The thyroid-heart axis-hormone dynamics and outcomes in cardiogenic shock following myocardial infarction.Journal of the Intensive Care Society · 2026Article
- Noradrenaline-trajectory phenotypes in septic shock: derivation and external validation in two independent cohorts.Intensive care medicine experimental · 2026Article
- Current and future strategies aiming at reducing catecholamine exposure in septic shock.Critical care (London, England) · 2026Review
- The C.O.S.T.A.S. project (Clinically Oriented Spasmolysis Treatment- A Scorescale): a pilot study.Brain & spine · 2026Article
- A predictive nomogram for in-ICU deterioration of stage 1 pressure injuries: a retrospective study.Frontiers in medicine · 2026Article
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Authors and funding
11 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundNoradrenaline is currently the first-line vasopressor in treatment of circulatory failure. Its dose reflects illness severity, and together with dopamine, dobutamine and adrenaline, it is used in the Sequential Organ Failure Assessment (SOFA) score to grade cardiovascular dysfunction. Over the years, noradrenaline use has increased and it has largely replaced dopamine. As part of the SOFA-2 update, we conducted a systematic review and dose-response meta-analysis to assess the association between noradrenaline dose and mortality.
methodsWe searched MEDLINE, Embase, and Web of Science from 1 January 2013 to 30 October 2024 for studies reporting mortality by noradrenaline dose in critically ill adults. The primary outcome was mortality. We generated pooled relative risks (RR) and assessed linear and non-linear dose-response relationships. Mortality was also analysed by SOFA-2 noradrenaline categories. The study followed PRISMA guidelines and was registered with PROSPERO (CRD42024501533).
resultsNineteen studies, including totally 29,935 patients, were included in the systematic review, and six in the meta-analysis. We observed a consistent increase in mortality: the relative risk escalated by a factor of 1.5 for every 0.1 µg/kg/min increase in peak noradrenaline dose. We did not find inflection points in the dose-mortality curve. In SOFA-2 categories, hospital mortality was 16.5% in the dose category ≤ 0.2 µg/kg/min, 31.9% in the category > 0.2 to 0.4 µg/kg/min, and 40.3% in the category > 0.4 µg/kg/min (p < 0.001).
conclusionsIn critically ill patients, escalating doses of noradrenaline correlate with an exponentially rising relative risk of mortality. This dose-dependent pattern reinforces the role of noradrenaline dose as a marker of cardiovascular failure severity.
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