The Relationship Between Delayed Vasopressor Usage and Mortality in Sepsis

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Medicine and Health Sciences


Introduction Delayed vasopressor initiation can occur with septic patients who arrive to the emergency department (ED) hemodynamically stable but decompensate later in their ED or hospital course. The relationship between delayed vasopressor initiation and mortality among septic patients is not well understood. Methods We performed a retrospective review of ED visits for sepsis by adult patients at two urban institutions from January 2010 - March 2015. Included patients were diagnosed with sepsis in the ED and had initial (< 3 hours) lactate in the “pre-shock” range of 2-4 mmol/L. Patients who received delayed (>3- but < 48-hours following ED arrival) vasopressors were compared to those who did not. Data were collected on patient demographics, vital signs, laboratory tests, medications given, length of ED and hospital stay, and mechanical ventilation status. Descriptive data analysis and group-wise comparisons were performed, including logistic regression. Results A total of 407 patients were included, with a mean age 65 years (SD 17.3). Mortality rate was 31% (61/197) among patients receiving delayed vasopressors [vs. 9.5% (20/210) for patients receiving no vasopressors (p=.0001)], and 38% (54) for those receiving mechanical ventilation [vs. 10% (27) among non-intubated patients]. Vasopressor usage (p=.0080; OR 2.32) and mechanical ventilation (p=.0001; OR 3.75) were both significant predictors of mortality. The majority (58%) of patients receiving delayed vasopressors were also mechanically ventilated. Median survival from time of ED arrival for those who died was 96 hours (Q1, Q3: 48, 240). Other variables, such as MAP, age, sex, lactate, and creatinine did not appear to predict mortality. Conclusions In this data set, we found that delayed initiation of vasopressors and mechanical ventilation were both independently associated with increased mortality for “pre-shock” septic patients. A significant proportion of those patients who received delayed vasopressors also received mechanical ventilation. Further study is needed, including larger data sets.


Copyright 2019 all authors


Nicholas G. Mazur1,2, Brian P. Reed MS1, Jacob E. Nouriel MD1, Lauren E. Shawver1, Auguste S. Niybizi1, Savannah R. O’Neil1, Sarah Meram1, Neelima Goyal1, James H. Paxton MD MBA1

1Wayne State University School of Medicine, Detroit, MI; 2Marian University College of Osteopathic Medicine, Indianapolis, IN

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