Time to vasopressor initiation and organ failure progression in early septic shock
Abstract 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 retro...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2020-06-01
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| Series: | Journal of the American College of Emergency Physicians Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/emp2.12060 |
| _version_ | 1826574693671370752 |
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| author | Lauren Page Black Michael A. Puskarich Carmen Smotherman Taylor Miller Rosemarie Fernandez Faheem W. Guirgis |
| author_facet | Lauren Page Black Michael A. Puskarich Carmen Smotherman Taylor Miller Rosemarie Fernandez Faheem W. Guirgis |
| author_sort | Lauren Page Black |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-12-12T13:18:59Z |
| format | Article |
| id | doaj.art-13d52b0a80054e30b907d325407c33b8 |
| institution | Directory Open Access Journal |
| issn | 2688-1152 |
| language | English |
| last_indexed | 2025-03-14T13:02:52Z |
| publishDate | 2020-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj.art-13d52b0a80054e30b907d325407c33b82025-03-02T02:42:42ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522020-06-011322223010.1002/emp2.12060Time to vasopressor initiation and organ failure progression in early septic shockLauren Page Black0Michael A. Puskarich1Carmen Smotherman2Taylor Miller3Rosemarie Fernandez4Faheem W. Guirgis5Department of Emergency Medicine University of Florida College of Medicine‐Jacksonville Jacksonville FloridaDepartment of Emergency Medicine University of Minnesota Minneapolis MinnesotaCenter for Data Solutions University of Florida College of Medicine‐Jacksonville Jacksonville FloridaDepartment of Emergency Medicine University of Florida College of Medicine‐Jacksonville Jacksonville FloridaDepartment of Emergency Medicine University of Florida College of Medicine Gainesville FloridaDepartment of Emergency Medicine University of Florida College of Medicine‐Jacksonville Jacksonville FloridaAbstract 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.https://doi.org/10.1002/emp2.12060hypotensionorgan failuresepsisseptic shockvasopressors |
| spellingShingle | Lauren Page Black Michael A. Puskarich Carmen Smotherman Taylor Miller Rosemarie Fernandez Faheem W. Guirgis Time to vasopressor initiation and organ failure progression in early septic shock Journal of the American College of Emergency Physicians Open hypotension organ failure sepsis septic shock vasopressors |
| title | Time to vasopressor initiation and organ failure progression in early septic shock |
| title_full | Time to vasopressor initiation and organ failure progression in early septic shock |
| title_fullStr | Time to vasopressor initiation and organ failure progression in early septic shock |
| title_full_unstemmed | Time to vasopressor initiation and organ failure progression in early septic shock |
| title_short | Time to vasopressor initiation and organ failure progression in early septic shock |
| title_sort | time to vasopressor initiation and organ failure progression in early septic shock |
| topic | hypotension organ failure sepsis septic shock vasopressors |
| url | https://doi.org/10.1002/emp2.12060 |
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