Concomitant Medications

The most commonly used vasoactive drugs were dopamine (94 admissions [44.1%]) and epinephrine (32 [15.0%]), followed by vasopressin (22 [10.3%]) and phenoxy- benzamine (13 [6.1%). Nephrotoxic medications (including aminoglycosides, vancomycin, acyclovir, ganciclovir, ampho- tericin, cidofovir, cyclosporine, tacrolimus, and sirolimus) were used in 58 (27.2%) of the admissions. Anticoagulants and platelet-lowering drugs (unfractionated heparin, low- molecular-weight heparin, warfarin) were used in less than 10% of admissions (21 and 22 admissions, respectively).

Clinical Outcomes

Low cardiac output syndrome was observed in 166 (77.9%) of the admissions. In 162 admissions, the patient had an AVO2 difference greater than 30%, and in 29 admissions there was an increase in lactate greater than 2 mmol/L (Table 1). In 25 of these admissions, (11.7% of the total), both criteria were recorded. Arrhythmia during milrinone use was documented in 82 (38.5%) of the admissions and thrombocytopenia in 27 (12.7%) (Table 1). kamagra soft tablets

Factors Independently Associated with Outcomes

Stepwise backward regression showed that 3 milrinone- related factors were independently associated with outcomes. First, there was a trend toward an association between higher average dose rate and low cardiac output syndrome (p = 0.053). Second, longer duration of milrinone therapy was associated with low cardiac output syndrome (p < 0.001). However, no statistically signficiant association was found between milrinione dosing and thrombocytopenia or arrhythmias (Table 3). None of the interaction terms tested was significant.

Table 3. Results of Multiple Logistic Regression


Variable

Pearson Correlation Coefficient

OR (95% CI)

Low cardiac output syndrome, defined as AVO2


> 30%


(n


= 213)



Milrinone average dose rate Dopamine dose No. of nephrotoxins Pacemaker
use Predicting outcome

(C

index) Hosmer-Lemeshow test

2.1053

(p= 0.053) 0.7238

(p= 0.012) -0.4664

(p= 0.015) 2.0845

(p= 0.009)

0.752 X2= 14.8, df = 8, p
= 0.062

0.21 (0.98-69.15) 2.06
(1.18-3.61)* 0.63 (0.43-0.91)* 8.04 (1.67-38.68)*


Low cardiac output syndrome, defined as lactate difference

> 2
mmol/L (n = 213)

Milrinone duration (cumulative) Predicting outcome
(C

index) Hosmer-Lemeshow test x
2

0.0114

(p< 0.001)

0.890
= 6.27, df = 8,

p= 0.61


1.01 (1.01-1.02)*


Arrhythmia (n = 213)

Milrinone average dose rate Dopamine dose Phenoxybenzamine dose
Pacemaker use Temperature on day


1


Number of anti-arrhythmic drugs Predicting outcome

(C

index) Hosmer-Lemeshow test



1.1164
(p= 0.23)

0.7053
(p= 0.002) -0.7601

(p= 0.13) 1.9665

(p< 0.001) 0.3349

(p= 0.040) 2.5286

(p= 0.001)

0.807 X2= 2.71, df = 8, p= 0.95



3.05 (0.50-18.77) 2.02 (1.29-3.18)* 0.47 (0.18-1.24)
7.14 (2.94-17.34)* 1.40 (1.02-1.92)* 12.54


(2.77-56.64)*


Platelet count

< 50


x 10
9/L
(n


= 213)



Milrinone loading dose (cumulative) Length of stay Dopamine dose
Phenoxybenzamine dose Epinephrine dose Predicting outcome

(C

index) Hosmer-Lemeshow test

-0.00313

(p= 0.53) 0.0468

(p= 0.020) 1.0214

(p= 0.001) 1.3615

(p= 0.016) 1.0376

(p= 0.010)

0.937 X2= 4.57, df = 8, p= 0.802


0.997(0.987-1.007) 1.05
(1.01-1.09)* 2.78 (1.50-5.14)* 3.90 (1.29-11.78)* 2.82 (1.28-6.24)*