Time to vasopressor initiation and organ failure progression in early septic shock

Lauren Page Black, Michael A. Puskarich, Carmen Smotherman, Taylor Miller, Rosemarie Fernandez, Faheem W. Guirgis

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Objective: Research evaluating the relationship between vasopressor initiation timing and clinical outcomes is limited and conflicting. We investigated the association between time to vasopressors, worsening organ failure, and mortality in patients with septic shock. Methods: This was a retrospective study of patients with septic shock (2013–2016) within 24 hours of emergency department (ED) presentation. The primary outcome was worsening organ failure, defined as an increase in Sequential Organ Failure Assessment (SOFA) score ≥2 at 48 hours compared to baseline, or death within 48 hours. The secondary outcome was 28-day mortality. Time to vasopressor initiation was categorized into 6, 4-hour intervals from time of ED triage. Multiple logistic regression was used to identify predictors of worsening organ failure. Results: We analyzed data from 428 patients with septic shock. There were 152 patients with the composite primary outcome (SOFA increase ≥2 or death at 48 hours). Of these, 77 patients died in the first 48 hours and 75 patients had a SOFA increase ≥2. Compared to the patients who received vasopressors in the first 4 hours, those with the longest time to vasopressors (20–24 hours) had increased odds of developing worsening organ failure (odds ratios [OR] = 4.34, 95% confidence intervals [CI] = 1.47–12.79, P = 0.008). For all others, the association between vasopressor timing and worsening organ failure was non-significant. There was no association between time to vasopressor initiation and 28-day mortality. Conclusions: Increased time to vasopressor initiation is an independent predictor of worsening organ failure for patients with vasopressor initiation delays >20 hours.

Original languageEnglish (US)
Pages (from-to)222-230
Number of pages9
JournalJournal of the American College of Emergency Physicians Open
Issue number3
StatePublished - Jun 2020

Bibliographical note

Funding Information:
: There was no external funding for this study but the authors report the following grant support for effort—LPB: NCATS KL2; MP: NIGMS K23 and the Minneapolis Medical Research Foundation; RF: Agency for Healthcare Research and Quality and the Department of Defense; FG: NIGMS K23. Funding and support

Publisher Copyright:
© 2020 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of the American College of Emergency Physicians.


  • hypotension
  • organ failure
  • sepsis
  • septic shock
  • vasopressors


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