Effects of adjunctive dobutamine on outcomes among patients with septic shock: a propensity score matching analysis

Lim, Sung Yoon; Lee, Kyu Jin; Jang, Yeonhoon; Lee, Yeon Joo; Ko, Ryoung-Eun; Suh, Gee Young; Oh, Dong Kyu; Lee, Su Yeon; Park, Mi Hyeon; Lim, Chae-Man; Park, Sunghoon; ,

doi:2025.40.6.990

Korean J Intern Med > Volume 40(6); 2025 > Article

ORIGINAL ARTICLE

Pulmonology

Korean J Intern Med. 2025;40(6):990-1001. doi: https://doi.org/10.3904/kjim.2024.432

Effects of adjunctive dobutamine on outcomes among patients with septic shock: a propensity score matching analysis

Sung Yoon Lim¹, Kyu Jin Lee², Yeonhoon Jang³, Yeon Joo Lee¹, Ryoung-Eun Ko⁴, Gee Young Suh⁴, Dong Kyu Oh⁵, Su Yeon Lee⁵, Mi Hyeon Park⁵, Chae-Man Lim⁵, Sunghoon Park⁶

, and on behalf of the Korean Sepsis Alliance (KSA) investigators

¹Department of Pulmonary and Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
²Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
³Department of Digital Healthcare, Seoul National University Bundang Hospital, Seongnam, Korea
⁴Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
⁵Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
⁶Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea

Corresponding Author: Sunghoon Park , Tel: +82-31-380-3715, Fax: +82-31-380-3973, Email: f2000tj@gmail.com

Received: December 22, 2024; Revised: March 22, 2025; Accepted: May 30, 2025.

Abstract

Background/Aims: Despite some evidence supporting its utility, the role of adjunctive dobutamine in the management of septic shock remains unclear.
Methods: The nationwide prospective sepsis cohort of the Korean Sepsis Alliance was analyzed. Adult patients with septic shock receiving norepinephrine were enrolled over a 29-month period. Patients given a dobutamine infusion within 3 days of intensive care unit (ICU) admission were compared with patients who received no infusion. To balance baseline characteristics, propensity score matching (PSM) was used.
Results: Of 11,981 patients with sepsis, 1,827 patients with septic shock receiving norepinephrine were included (108 dobutamine vs. 1,719 no dobutamine; mean age 71.4 ± 13.2 years, 59.4% male). After PSM (ratio of 1:2; 105 dobutamine patients and 209 no-dobutamine patients), Sequential Organ Failure Assessment scores and lactate levels on ICU day 3 did not significantly differ between groups. Additionally, in-hospital and ICU mortality rates did not differ between groups (54.3% vs. 48.3%, p = 0.319; 46.7% vs. 39.2%, p = 0.208, respectively). A Cox proportional model revealed that dobutamine use was not associated with in-hospital mortality (HR 1.13, 95% CI 0.81–1.58). However, subgroup analysis indicated that dobutamine use was associated with an increased risk of in-hospital mortality among patients in the lowest quintile of early fluid balance (p = 0.0286 for interaction).
Conclusions: Adjunctive dobutamine administration did not improve short-term organ function or hospital outcomes in septic shock patients. However, early fluid balance may influence the impact of dobutamine, highlighting the importance of a more tailored approach.

Keywords: Dobutamine ; Shock, septic ; Fluid therapy