Norepinephrine Onset Time and Mortality in Patients with Septic Shock Treated in the Emergency Department

Introduction: Sepsis, and particularly septic shock, is a life-threatening condition associated with high mortality rates in the emergency department. Timely interventions can significantly reduce these unacceptably high mortality rates. While some studies have demonstrated reduced mortality with early norepinephrine initiation, there is limited research on this intervention specifically within the emergency department setting. The objective of this study was to determine the association between the time to norepinephrine initiation in the emergency department and in-hospital mortality in adult patients diagnosed with septic shock. Methods: This retrospective cohort study included adult patients diagnosed with septic shock in the emergency department. Demographics, paraclinical variables, and the time to norepinephrine initiation were evaluated. In-hospital mortality was defined as the primary outcome. Finally, a multivariate analysis was performed to develop a nomogram for predicting septic shock mortality from the emergency department. Results: A total of 176 patients were included. A significant difference was documented between the time to norepinephrine initiation (in minutes) and survival rates: median (IQR) 12 (2-29) min for survivors versus 104 (68-181) min for non-survivors (p < 0.001). Similarly, when the time to initiation was divided into three groups (<60, 61-179, >179 min), a differential association with mortality was observed: OR 0.16 (95% CI; 0.08-0.32), OR 5.59 (95% CI; 2.67-11.6), and OR 353 (95% CI; 20.8-5978.9), respectively. Additionally, variables associated with mortality included mean arterial pressure, arterial lactate, and creatinine levels. Conclusions: Early initiation of norepinephrine in the emergency department may lower in-hospital mortality from septic shock without raising arrhythmia rates. Further high-quality studies are needed to confirm this and identify the patients who would benefit most.