Catecholamines are the first-line vasopressors used in patients with septic shock. However, the search for novel drug candidates is still of great importance due to the development of adrenergic hyposensitivity accompanied by a decrease in catecholamine activity. Terlipressin (TP) is a synthetic vasopressin analogue used in the management of patients with septic shock. In the current study, we aimed to compare the effects of TP and catecholamine infusion in treating septic shock patients. A systematic review and meta-analysis was conducted by searching articles published in PUBMED, EMBASE, and the Cochrane Central Register of Controlled Trials between inception and July 2018. We only selected randomized controlled trials evaluating the use of TP and catecholamine in adult patients with septic shock. The primary outcome was overall mortality. The secondary outcomes were the ICU length of stay, haemodynamic changes, tissue perfusion, renal function, and adverse events. A total of 9 studies with 850 participants were included in the analysis. Overall, no significant difference in mortality was observed between the TP and catecholamine groups (risk ratio(RR), 0.85 (0.70 to 1.03); P = 0.09). In patients < 60 years old, the mortality rate was lower in the TP group than in the catecholamine group (RR, 0.66 (0.50 to 0.86); P = 0.002). There was no significant difference in the ICU length of stay (mean difference, MD), − 0.28 days; 95% confidence interval (CI), − 1.25 to 0.69; P = 0.58). Additionally, TP improved renal function. The creatinine level was decreased in patients who received TP therapy compared to catecholamine-treated participants (standard mean difference, SMD), − 0.65; 95% CI, − 1.09 to − 0.22; P = 0.003). No significant difference was found regarding the total adverse events (Odds Ratio(OR), 1.48(0.51 to 4.24); P = 0.47), whereas peripheral ischaemia was more common in the TP group (OR, 8.65(1.48 to 50.59); P = 0.02). The use of TP was associated with reduced mortality in septic shock patients less than 60 years old. TP may also improve renal function and cause more peripheral ischaemia. PROSPERO registry: CRD42016035872.

中文翻译：

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特利加压素用于治疗成人败血症性休克：系统评价和荟萃分析。

儿茶酚胺是败血性休克患者使用的一线血管加压药。然而，由于肾上腺素能敏感性降低并伴随儿茶酚胺活性下降，寻找新的候选药物仍然非常重要。特利加压素（TP）是一种合成的加压素类似物，用于败血性休克患者的治疗。在本研究中，我们旨在比较TP和儿茶酚胺输注治疗败血性休克患者的效果。通过检索在PUBMED，EMBASE和Cochrane对照试验中央注册簿中发表的文章，从开始到2018年7月进行了系统的综述和荟萃分析。我们仅选择了评估成人败血症患者使用TP和儿茶酚胺的随机对照试验。休克。主要结局是总体死亡率。次要结果是ICU住院时间，血流动力学变化，组织灌注，肾功能和不良事件。分析共包括9项研究，共有850名参与者。总体而言，TP和儿茶酚胺组之间的死亡率没有显着差异（风险比（RR）为0.85（0.70至1.03）； P = 0.09）。在<60岁的患者中，TP组的死亡率低于儿茶酚胺组（RR，0.66（0.50至0.86）； P = 0.002）。ICU住院时间无显着差异（平均差异，MD），为-0.28天；95％置信区间（CI）-1.25至0.69; P = 0.58）。另外，TP改善肾功能。与接受儿茶酚胺治疗的参与者相比，接受TP治疗的患者的肌酐水平降低了-0.65；95％CI，-1.09至-0.22；P = 0.003）。在总的不良事件方面没有发现显着差异（赔率（OR）为1.48（0.51至4.24）； P = 0.47），而TP组外周血缺血更为普遍（OR为8.65（1.48至50.59）； P = 0.02）。TP的使用与60岁以下败血性休克患者的死亡率降低相关。TP也可能改善肾功能并引起更多的周围缺血。PROSPERO注册表：CRD42016035872。TP也可能改善肾功能并引起更多的周围缺血。PROSPERO注册表：CRD42016035872。TP也可能改善肾功能并引起更多的周围缺血。PROSPERO注册表：CRD42016035872。