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Observational Study
. 2022 Apr 1;50(4):e351-e360.
doi: 10.1097/CCM.0000000000005363.

Vasopressor Initiation Within 1 Hour of Fluid Loading Is Associated With Increased Mortality in Septic Shock Patients: Analysis of National Registry Data

Hye Ju Yeo  1   2 , Young Seok Lee  3 , Tae Hwa Kim  1   2 , Jin Ho Jang  1   2 , Heung Bum Lee  4 , Dong Kyu Oh  5 , Mi Hyeon Park  5 , Chae-Man Lim  5 , Woo Hyun Cho  1   2 ; Korean Sepsis Alliance (KSA) Investigators
Affiliations
Observational Study

Vasopressor Initiation Within 1 Hour of Fluid Loading Is Associated With Increased Mortality in Septic Shock Patients: Analysis of National Registry Data

Hye Ju Yeo et al. Crit Care Med. .

Abstract

Objectives: To investigate whether administration of a vasopressor within 1 hour of first fluid loading affected mortality and organ dysfunction in septic shock patients.

Design: Prospective, multicenter, observational study.

Setting: Sixteen tertiary or university hospitals in the Republic of Korea.

Patients: Patients with septic shock (n = 415) were classified into early and late groups according to whether the vasopressor was initiated within 1 hour of the first resuscitative fluid load. Early (n = 149) patients were 1:1 propensity matched to late (n = 149) patients.

Interventions: None.

Measurement and main results: The median time from the initial fluid bolus to vasopressor was shorter in the early group (0.3 vs 2.3 hr). There was no significant difference in the fluid bolus volume within 6 hours (33.2 vs 35.9 mL/kg) between the groups. The Sequential Organ Failure Assessment score and lactate level on day 3 in the ICU were significantly higher in the early group than that in the late group (Sequential Organ Failure Assessment, 9.2 vs 7.7; lactate level, 2.8 vs 1.7 mmol/L). In multivariate Cox regression analyses, early vasopressor use was associated with a significant increase in the risk of 28-day mortality (hazard ratio, 1.83; 95% CI, 1.26-2.65).

Conclusions: Vasopressor initiation within 1 hour of fluid loading was associated with higher 28-day mortality in patients with septic shock.

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Conflict of interest statement

Dr. Lim received support for article research from the 2019 Research Grant (2019E280500) from the Korean Disease Control and Prevention Agency. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Comment in

References

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    1. Shi R, Hamzaoui O, De Vita N, et al.: Vasopressors in septic shock: Which, when, and how much? Ann Transl Med 2020; 8:794
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    1. Scheeren TWL, Bakker J, De Backer D, et al.: Current use of vasopressors in septic shock. Ann Intensive Care 2019; 9:20

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