Bedside monitoring of the vascular response to norepinephrine in early septic shock: VNERi trajectories and comparison with dynamic clinical measures
Authors' conclusion
Serial bedside VNERi monitoring is feasible and carries a partly independent signal that adds a small amount to dynamic clinical severity without outperforming it. These findings are hypothesis-generating and need validation in a hyporesponsive population.
Study context
- Population
- Adults with septic shock started on first-line norepinephrineadults with septic shock
- Participants
- 94 adults
- Exposure
- VNERi course parameters (mean level, minimum, slope) vs ΔSOFA and lactate clearance for 28-day mortality
- Outcome
- 28-day mortality
- Follow-up
- 28 days
Main finding
As reported in the abstract
Mortality
32%
30/94
Observational data: associations, not effects.
Further findings
| Outcome | HR | P value |
|---|---|---|
| Higher VNERi(t) and survival (time-dependent Cox)Higher VNERi(t) · unadjusted | 0.48 | |
| Higher VNERi(t) and survival (time-dependent Cox)Higher VNERi(t) · after adjusting for SOFA(t); non-significant | 0.68 | P = 0.08 |
Baseline VNERi discrimination of 28-day mortality
- AUC
- 0.59
- Most had a preserved response
VNERi course parameters vs ΔSOFA discrimination of 28-day mortality · T0-T48
- VNERi mean-level AUC
- 0.73
- ΔSOFA AUC
- 0.84
- Window-matched DeLong
- P = 0.02
- Did not outperform ΔSOFA
VNERi added to a dynamic clinical model
- Integrated discrimination improvement
- 0.05-0.06
- Likelihood-ratio
- p ≈ 0.02
- Small gain
Exploratory course phenotypes (latent class mixed model) and survival
- Three exploratory course phenotypes separated survival
- log-rank p = 0.002
Original publication
Bedside monitoring of the vascular response to norepinephrine in early septic shock: VNERi trajectories and comparison with dynamic clinical measures. J Clin Monit Comput. Published 9 October 2026. doi:10.
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