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. 2025 Nov 3:S0196-0644(25)01238-7.
doi: 10.1016/j.annemergmed.2025.09.024. Online ahead of print.

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

Lauren Page Black  1 , Charlotte Hopson  2 , Michael A Puskarich  3 , François Modave  4 , Danielle M McCarthy  5 , Elizabeth DeVos  6 , Cynthia Garvan  7 , Rosemarie Fernandez  2 , Faheem W Guirgis  2
Affiliations

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

Lauren Page Black et al. Ann Emerg Med. .

Abstract

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.

Keywords: Resuscitation; Sepsis; Septic shock; Vasopressor initiation; Vasopressors.

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Conflict of interest statement

Conflicts of Interest

LPB (Primary and Corresponding Author): No Conflicts of Interest

MAP: (Inflammatix, Opticyte, Cytovale)

FWG: (Inflammatix, Abbott)

ED: Inflammatix (Site PI, INF-04). The product is not discussed In this paper and the study was not in progress during the years of the data set.

Consulting for work not directly related to the content of the current manuscript (MAP, ED, FWG).

All other authors disclose no competing conflicts of interest.

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