ArticleClinical epidemiology2026
Timing of Core Sepsis Bundle Elements Initiation in Critically Ill Patients: A Multicenter Target Trial Emulation Study.
Article in Clinical epidemiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
- Rapid identification of microbial pathogens in intra-abdominal infections using multiplex PCR.Frontiers in cellular and infection microbiology · 2026Observational
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Authors and funding
16 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Purpose: One-hour sepsis bundle was developed in 2018. However, the optimal timing for antibiotic, fluid resuscitation, and vasopressor initiation in intensive care units (ICUs) remains debated. High-quality randomized evidence is limited, particularly for ICU patients. Therefore, we emulated three target trials using observational data. Patients and Methods: We conducted a retrospective, multicenter cohort study using data from the Medical Information Mart for Intensive Care-IV database (primary dataset), and two ICU cohorts from China (Zhujiang and Xiangya hospitals). Within a target trial emulation framework with inverse probability of treatment weighting, we constructed three two-arm trials comparing initiation of (1) antibiotics, (2) fluid resuscitation, and (3) vasopressors within 0-1 hour versus 1-3 hours after a prespecified time zero. Results: In the target trial emulations, antibiotic initiation within 1 hour was associated with lower 28-day mortality (HR 0.65; 95% CI 0.54-0.79) and earlier ICU discharge (competing-risk analysis; SHR 1.20; 95% CI 1.12-1.27) compared with initiation at 1-3 hours. For fluid resuscitation, initiating within 1 hour and delivering ≥30 mL/kg crystalloid within 3 hours resulted in lower mortality (HR 0.72; 95% CI 0.53-0.97) and earlier discharge (SHR 1.17; 95% CI 1.02-1.33). However, vasopressor initiation within 1 hour showed no survival benefit (HR 1.07; 95% CI 0.89-1.29) or reduction in time to ICU discharge (SHR 1.02; 95% CI 0.95-1.08). These findings remained consistent across sensitivity and subgroup analyses, including comparisons using a 1-6 hour window. Conclusion: In ICUs, early administration of antibiotics and initiation of fluid resuscitation within 1 hour were associated with improved survival and earlier ICU discharge, whereas early vasopressor use was not. These findings might support a bedside emphasis on timely antibiotics and fluids during early resuscitation and provide evidence for refining time targets in future sepsis guidelines.
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