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

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STUDY OBJECTIVE: The optimal timing of vasopressor initiation in septic shock remains unclear. Our objective was to evaluate the association between time to vasopressor initiation and mortality. METHODS: This was a retrospective cohort study of patients with septic shock in the OneFlorida Data Trust, a statewide repository of health care data. We included patients if they received vasopressors during hospitalization after at least 1 episode of hypotension (systolic blood pressure ≤100 mmHg) and had either (1) an International Classification of Disease 9 or 10 code for sepsis, or (2) an International Classification of Disease code for infection and received IV antibiotics. The primary outcome was 90-day mortality. The secondary outcome was vasopressor-free days. We used multiple logistic regression with Least Absolute Shrinkage and Selection Operator for variable selection to assess associations with 90-day mortality. RESULTS: There were 4,699 patients with septic shock between 2012 and 2018 included. The primary outcome, 90-day mortality, was present in 34% (n=1,610). Time to vasopressor initiation was not found to be associated with 90-day mortality (odds ratio [OR] 1.01; 95% confidence interval [CI] 1.00 to 1.02). Independent predictors included age (OR 1.04; 95% CI 1.04 to 1.05), mechanical ventilation (OR 2.98; 95% CI 2.56 to 3.48), laboratory components of the Sequential Organ Failure Assessment score (OR 1.18; 95% CI 1.14 to 1.23), lactate level (OR 1.10; 95% CI 1.08 to 1.13), chronic hypertension (OR 0.60; 95% CI 0.52 to 0.70), and liver disease (OR 1.54; 95% CI 1.30 to 1.82). Time to vasopressor initiation was not found to be an independent predictor of vasopressor-free days. CONCLUSION: Time from first hypotensive episode to vasopressor initiation was not found to be associated with 90-day mortality or vasopressor-free days in this large cohort of septic shock patients.

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