Adjunctive use of midodrine in patients with septic shock: a meta-analysis

SESSION TITLE: Sepsis: Novel Identification and Treatment SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: Prior meta-analyses suggested that the adjunctive use of midodrine was not associated with early liberation of vasopressors, decrease in the length of ICU and hospital stay and may increase risk of bradycardia among patients with different types of shock. We hypothesized that there may be selective benefit of adjunctive use of midodrine in patients with septic shock. We aimed to compare the efficacy and safety of adjunctive use of midodrine compared to standard therapy in patients with septic shock by means of a meta-analysis. METHODS: A comprehensive literature search were performed in PubMed, Embase and Cochrane databases through January 2023 for relevant studies. Outcomes of interest include length of ICU and hospital stay, duration of IV vasopressors use, reinitiation of vasopressors, in-hospital/28-day mortality and incidence of bradycardia. Endpoints were pooled using random-effects Hartung-Knapp-Sidik-Jonkman model and were expressed as odds ratio for categorical variables and standardized mean differences for continuous variables with their corresponding 95% confidence intervals. RESULTS: 3 studies (2 RCTs and 1 observational study) with a total of 363 patients with septic shock are included in the final analysis. 180 patients received midodrine in addition to IV vasopressors while 183 patients received IV vasopressors only. Results of meta-analysis showed that midodrine group was associated with a shorter length of ICU stay compared to IV vasopressors only group (SMD -0.30, 95% CI-0.52 to -0.07, p=0.01). There was a trend of non-significant shorter length of hospital stay (SMD -0.14, 95% CI-0.36 to 0.07, p=0.20), duration of IV vasopressor use (SMD -0.28, 95% CI-0.69 to 0.13, p=0.19) and a non-significant lower odds of reinitiation of vasopressor (OR 0.46, 95% CI 0.20 to 1.06, p=0.07). There was also no difference in terms of in-hospital/28-day mortality (OR 0.57, 95% CI 0.28 to 1.17, p=0.13) and the incidence of bradycardia (OR 1.89, 95% CI 0.15 to 23.82, p=0.62) between both groups. CONCLUSIONS: Our results showed that adjunctive use of midodrine may be beneficial in shorterning the length of ICU stay without increase risk of bradycardia or mortality. Further large randomized controlled trials are warranted to confirm these findings. CLINICAL IMPLICATIONS: In contrary to results of prior meta-analysis with heteregenous population, the adjunctive use of midodrine in patients with septic shock appears to be safe and may have a role in reducing the length of ICU stay. Results are hypothesis-generating and further large RCTs are warranted. DISCLOSURES: No relevant relationships by Song Peng Ang No relevant relationships by Amanda Chajkowski No relevant relationships by Jia Ee Chia No relevant relationships by Jose Iglesias No relevant relationships by Vikash Jaiswal No relevant relationships by Masih Lali No relevant relationships by saria qaiser No relevant relationships by Nashwa Yosry