TOPLINE:

Time to vasopressor initiation from the first hypotensive episode was not significantly associated with 90-day mortality or vasopressor-free days in patients with septic shock, according to a new study. The median initiation time was 2.68 hours, and the 90-day mortality rate was 34%.

METHODOLOGY:

• Researchers conducted a retrospective cohort analysis of 4699 patients (median age, 62.3 years; 54.7% men; 69.1% White individuals; 66% with hypertension) with septic shock from the OneFlorida Data Trust database between 2012 and 2018.
• Patients who received vasopressors after documented hypotension (systolic blood pressure ≤ 100 mm Hg) and had either an International Classification of Disease 9/10 code for sepsis or an infection-related code plus intravenous antibiotics were included.
• The primary outcome was 90-day mortality, and the secondary outcomes were in-hospital death and vasopressor-free days.
• Sensitivity analyses were conducted on patients with an incalculable time to vasopressor initiation (n = 1815) and on patients meeting the hypotension cutoff of systolic blood pressure ≤ 90 mm Hg (n = 4101).

TAKEAWAY:

• The 90-day mortality rate was 34%, and the in-hospital mortality rate was 26%. The median time to vasopressor initiation was 2.68 hours from the first hypotensive episode, and patients had a median of 23 vasopressor-free days after the first hypotensive episode.
• Time to vasopressor initiation showed no significant association with 90-day mortality when analyzed as either a continuous variable (odds ratio [OR], 1.01; 95% CI, 1.00-1.02) or in 2-hour intervals. It was also not significantly associated with vasopressor-free days. Sensitivity analyses confirmed these results.
• Independent predictors of 90-day mortality included age (OR, 1.04; 95% CI, 1.04-1.05), mechanical ventilation use (OR, 2.98; 95% CI, 2.56-3.48), lactate level (OR, 1.10; 95% CI, 1.08-1.13), laboratory Sequential Organ Failure Assessment score (OR, 1.18; 95% CI, 1.14-1.23), liver disease (OR, 1.54; 95% CI, 1.30-1.82), and chronic hypertension (OR, 0.60; 95% CI, 1.52-0.70).

IN PRACTICE:

"In this large cohort of septic shock patients, time from first hypotensive episode to vasopressor initiation was not found to be associated with 90-day mortality or vasopressor-free days," the authors wrote. "Whether there is heterogeneity in response to time to vasopressor initiation among select groups of patients remains unknown and needs continued investigation," they added.

SOURCE:

The study was led by Lauren Page Black, MD, MPH, Northwestern University, Feinberg School of Medicine, Chicago. It was published online on November 04, 2025, in Annals of Emergency Medicine.

LIMITATIONS:

The study was limited by its retrospective, observational design, preventing the establishment of causality. The dynamic nature of septic shock management and fluid responsiveness were not fully captured. Data were restricted to Florida facilities, reducing generalizability, and residual confounding may have further affected the results.

DISCLOSURES:

The study was supported by the OneFlorida+ Clinical Research Network, funded by the Patient-Centered Outcomes Research Institute; OneFlorida+ Cancer Control Alliance, funded by the Florida Department of Health's James and Esther King Biomedical Research Program; Université de Franche-Comté and Translational Science Institute, funded by the National Institutes of Health National Center for Advancing Translational Sciences; and awards from the National Center for Advancing Translational Sciences and the National Institute of General Medical Sciences. Several authors disclosed having consulting relationships with Inflammatix, Opticyte, Cytovale, and Abbott outside the submitted work. Detailed disclosures are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.