Time to Vasopressor Initiation Is Not Associated With Increased Mortality in Patients With Septic Shock

Area of Science:

• Critical Care Medicine
• Epidemiology
• Health Services Research

Background:

• The optimal timing for initiating vasopressor therapy in patients with septic shock is a critical but unresolved clinical question.
• Early vasopressor administration is often presumed to improve outcomes, but robust evidence is lacking.

Purpose of the Study:

• To investigate the association between the time to vasopressor initiation and 90-day mortality in a large cohort of septic shock patients.
• To identify other independent predictors of mortality in septic shock.

Main Methods:

• Retrospective cohort study utilizing the OneFlorida Data Trust, a statewide healthcare data repository.
• Inclusion criteria: patients with septic shock, hypotension, and sepsis or infection with antibiotic treatment.
• Primary outcome: 90-day mortality, analyzed using multivariable logistic regression with LASSO variable selection.

Main Results:

• A total of 4,699 patients with septic shock were analyzed (2012-2018).
• 90-day mortality was 34%. Time to vasopressor initiation was not significantly associated with 90-day mortality (OR 1.01, 95% CI 1.00-1.02).
• Independent predictors of mortality included age, mechanical ventilation, SOFA score components, lactate, chronic hypertension, and liver disease.

Conclusions:

• In this large cohort, the time from the first hypotensive episode to vasopressor initiation was not associated with 90-day mortality.
• The timing of vasopressor initiation did not influence vasopressor-free days.
• Factors such as age, ventilation status, organ dysfunction, and comorbidities are more significant predictors of septic shock outcomes.