ArticleCritical care explorations2024
Septic Shock Requiring Three Vasopressors: Patient Demographics and Outcomes.
Article in Critical care explorations, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Effect of Weight-based versus Absolute Norepinephrine Dosing on Mortality Risk in Obese Patients with Septic Shock: An Observational, Multicohort, Retrospective Study.Anesthesiology · 2026Observational
- Intraoperative vasopressor use as a risk factor for early periprosthetic joint infection after total joint arthroplasty: A retrospective cohort study.Journal of orthopaedics · 2026Article
- The Impact of Age on In-Hospital Mortality in Patients with Sepsis: Findings from a Nationwide Study.Journal of clinical medicine · 2025Article
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Authors and funding
11 authors.
Funding
Abstract
objectivesSeptic shock is a common condition necessitating timely management including hemodynamic support with vasopressors. Despite the high prevalence and mortality, there is limited data characterizing patients who require three or more vasopressors. We sought to define the demographics, outcomes, and prognostic determinants associated with septic shock requiring three or more vasopressors.
designThis is a multicenter retrospective cohort of two ICU databases, Medical Information Mart for Intensive Care IV (MIMIC-IV) and electronic ICU-Clinical Research Database, which include over 400,000 patients admitted to 342 ICUs. PATIENTS: Inclusion criteria entailed patients who were: 1) age 18 years old and older, 2) admitted to any ICU, 3) administered at least three vasopressors for at least 2 hours at any time during their ICU stay, and 4) identified to have sepsis based on the Sepsis-3 criteria.
interventionsNone. MEASUREMENTS AND MAIN
resultsA total of 3447 patients met inclusion criteria. The median age was 67 years, 60.5% were male, and 96.6% had full code orders at the time of the third vasopressor initiation. Septic shock requiring three or more vasopressors was associated with 57.6% in-hospital mortality. Code status changes occurred in 23.9% of patients following initiation of a third vasopressor. Elevated lactate upon ICU admission (odds ratio [95% CI], 2.79 [2.73-2.85]), increased duration of time between ICU admission and third vasopressor initiation (1.78 [1.69-1.87]), increased serum creatinine (1.61 [1.59-1.62]), and age above 60 years (1.47 [1.41-1.54]) were independently associated with an increased risk of mortality based on analysis of the MIMIC-IV database. Non-White race and Richmond Agitation-Sedation Scale scores were not associated with mortality.
conclusionsSeptic shock requiring three vasopressors is associated with exceptionally high mortality. Knowledge of patients at highest risk of mortality in this population may inform management and expectations conveyed in shared decision-making.
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