Time-to-vasopressors and clinical outcome by level of diastolic blood pressure and pulse pressure in patients with septic shock: a retrospective analysis of prospective multicenter cohort study
Authors' conclusion
The relationship between vasopressor timing and outcomes in septic shock is hemodynamic phenotype dependent. Early norepinephrine appears beneficial when DBP is markedly low, particularly with wide PP, and less critical when DBP is preserved or PP is narrow.
Study context
- Population
- Adults with septic shock presenting to EDs, national sepsis registry (2019–2024)
- Participants
- 1,104 adults
- Exposure
- Early (≤ 25 min) vs later norepinephrine initiation, stratified by diastolic blood pressure (DBP) and pulse pressure
- Outcome
- In-hospital mortality
Methodological detailsnational sepsis registry, multivariable-adjusted, prespecified stratification by DBP and pulse pressure
- National sepsis registry
- Multivariable-adjusted
- Prespecified stratification by DBP and pulse pressure
Main finding
As reported in the abstract
In-hospital mortality by pre-vasopressor DBP (subgroup)
- Early norepinephrine associated with lower mortality only with low DBP (< 50 mmHg)
- No mortality benefit when DBP ≥ 50 mmHg
Observational data: associations, not effects.
Further findings
In-hospital mortality at alternative DBP thresholds (< 40, < 44 mmHg) (sensitivity analysis)
- Stronger mortality associations at more extreme diastolic hypotension thresholds
In-hospital mortality by pulse pressure within low-DBP (subgroup)
- Wide pulse pressure (PP) (≥ 25 mmHg): most pronounced survival association with immediate vasopressors
- Narrow PP: no clear benefit
Sensitivity and subgroup analyses
- Results directionally consistent
Original publication
Time-to-vasopressors and clinical outcome by level of diastolic blood pressure and pulse pressure in patients with septic shock: a retrospective analysis of prospective multicenter cohort study. Crit Care. Published 27 January 2026. doi:10.
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