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

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.