Applicability of Vasopressor Trials in Adult Critical Care: A Prospective Multicentre Meta-Epidemiologic Cohort Study

Figures & data

Table 1 Characteristics of the Study Cohort

Variable
Demographics		Patients (n=744)
	Age, years, n=736	68 (56–76)
	Male sex, n (%), n=744	468 (63)
	BMI, kg/m^2, n=664	26.12 (23.86–29.56)
Type of critical care		Cases (n=1112)
	Medical	846 (76)
	Surgical	266 (24)
	Emergency	180 (16)
	Elective	86 (8)
Indication for vasopressor treatment		Cases (n=1189)
Shock	Shock type
	Distributive	366 (31)
	Septic	341 (29)
	Anaphylactic	3 (0)
	Neurogenic	22 (2)
	Cardiogenic	376 (32)
	Obstructive	19 (2)
	Hypovolemic	36 (3)
	Intoxication	4 (0)
	Mixed or unknown	311 (26)
Surgery		77 (7)
Vasopressor		Cases (n=1202)*
	Norepinephrine	788 (66)
	Epinephrine	89 (7)
	Phenylephrine	33 (3)
	Dopamine	1 (0)
	Vasopressin	144 (12)
	Terlipressin	0 (0)
Inotropic agent	Dobutamine	147 (12)

Notes: *In 13 cases, two vasoactive agents were started simultaneously and therefore counted as single time points.

Figure 1 Proportions with 95% confidence intervals of matching study cases and proportions of cases eligible for reference RCTs.

Notes: (A) The median proportion of matching cases was 2.5% (red dotted line) with 95% CI 1.3–6.0 (band). For example, 49% (95% CI 34–70) of the study cases matched the criteria for RCT #1 (De Backer 2010), while 0% of the cases matched the criteria for RCT #20 (Dünser 2003). X-axis: Individual RCTs. Y-axis: Proportion of matching cases (%) with 95% CIs (bars). (B) Proportion of cases (Y-axis) eligible for reference RCTs (X-axis). For example, 26% of cases (n=308) were eligible for 0 RCTs, 74% of cases (n=881) were eligible for 1 RCT, and 41% of cases (n= 482) were eligible for 2 trials.

Figure 2 Eligibility criteria contributing most to the trial ineligibility of study cases.

Notes: Ineligibility proportions are visualized with colours (from green [low proportion] to red [high proportion]). X axis: Individual RCTs. Y axis: Eligibility criteria, total number (n) and percentage (%) of RCTs using the criteria. The eligibility criteria are listed in descending order of ineligibility proportions.

Figure 3 Median PRECIS-2 scores of the RCTs included in the Cochrane review and their relation to the eligibility proportions of the study cases.

Notes: (A) PRECIS-2 scores of the 25 RCTs included in the Cochrane review. The lowest and highest PRECIS-2 scores were recorded as 22 and 35 points, respectively. The median PRECIS-2 score of all 25 trials was 29 points (IQR 27–31), which can be interpreted as moderate level of pragmatism. (B) PRECIS-2 scores of RCTs vs matching cases (%): The proportion of matching cases increased with a higher PRECIS-2 score. X-axis: PRECIS-2 score. Y-axis: Proportion of matching cases (%). PRECIS-2, PRagmatic Explanatory Continuum Indicator Summary.

Figure 4 Eligibility proportions of study cases vs recruitment-to-screening ratios of 13 RCTs.

Notes: Only 13 RCTs reported the number of screened patients in the main text. A higher recruitment-to-screening ratio was not associated with higher matching proportions. X-axis: Recruitment-to-screening ratio of 13 RCTs (%). Y-axis: Proportion of matching cases (%). The displayed line represents the line of identity, where values on X equal Y. With the current study considered an example of a maximum pragmatic design, only three RCTs showed the same level of pragmatism with recruitment-to-screening ratios of 8, 12 and 44%.