Shortage of Norepinephrine Linked to Increase in Septic Shock Deaths

During the norepinephrine shortage, phenylephrine was the most used alternative vasopressor to treat septic shock.
During the norepinephrine shortage, phenylephrine was the most used alternative vasopressor to treat septic shock.

When drug shortages happen in the United States, their impact on patient care and outcomes is not commonly reported.

Emily Vail, MD, from Columbia University, New York, NY, and coauthors aimed to evaluate changes to patient care and outcomes tied to a nationwide shortage of norepinephrine in 2011. Norepinephrine is a first-line vasopressor agent for septic shock.

Dr Vail led a retrospective cohort study of US hospitals in the Premier Healthcare Database with a baseline rate of norepinephrine use of ≥60% for patients with septic shock. A total of 27,835 adults with septic shock admitted to those hospitals between July 2008 and June 2013 were included. 

Hospital-level shortage of norepinephrine was defined as any 3-month interval in 2011 where the hospital rate of norepinephrine use reduced by >20% from baseline. Study authors measured the use of alternative vasopressor drugs and evaluated the association between hospital admission during a norepinephrine shortage quarter and in-hospital mortality. 

Of the total patients with septic shock in the hospitals that had ≥1 quarter of norepinephrine shortage in 2011, its use among cohort patients decreased from 77% (95% CI: 76.2–77.8)  to 55.7% (95% CI: 52–58.4) in the second quarter of 2011. During this time, phenylephrine was the most commonly used alternative vasopressor (baseline 36.2%, 95% CI: 35.3–37.1 to maximum 54.5%, 95% CI: 51.8–57.2). 

When compared to hospital admission with septic shock during quarters of normal use, there was a higher rate of in-hospital mortality during quarters of shortage (35.9% vs. 39.6%, respectively; absolute risk increase 3.7%, 95% CI: 1.5–6.0; adjusted odds ratio 1.15, 95% CI: 1.01–1.30; P=0.03).

Dr Vail concluded that the among septic shock patients affected by the norepinephrine shortage in 2011, there was a higher rate of in-hospital mortality and the most commonly given alternative was phenylephrine.

Reference

Vail E, Gershengorn HB, Hua M, et al. Association between US norepinephrine shortage and mortality among patients with septic shock [published online March 21, 2017]. JAMA. doi: doi:10.1001/jama.2017.2841.

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