ArticleAnnals of intensive care2026
Association between time to target mean arterial pressure and 90-day mortality in septic shock: a post hoc analysis of the OPTPRESS trial.
Article in Annals of intensive care, 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.
- Is arterial hypotension the real enemy in septic shock or is it just cosmetic?Annals of intensive care · 2026Article
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7 authors.
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Abstract
Background: In septic shock resuscitation, maintaining a mean arterial pressure (MAP) of at least 65 mmHg is recommended; however, the clinical relevance of the time required to achieve target MAP remains unclear. We evaluated the association between time to target MAP (TTT-MAP) and clinical outcomes in septic shock. Methods: This post hoc secondary analysis used data from the OPTPRESS randomized controlled trial. TTT-MAP was defined as the time from randomization to first attainment of the randomized-arm lower-bound MAP target (80 mmHg in the high-target arm; 65 mmHg in the low-target arm) and categorized as <1 h, 1-3 h, 3-6 h, 6-12 h, ≥12 h, and unreached. The primary outcome was 90-day all-cause mortality. The primary analysis used doubly robust estimation. Secondary analyses included continuous TTT-MAP modeling, Cox proportional hazards models, and assessments of hypotension burden and vasopressor exposure. Results: Among 516 patients enrolled in OPTPRESS, 476 were included in the complete-case cohort. In the primary six-category analysis, compared with TTT-MAP <1 h, the delayed-attainment category (≥12 h) was associated with higher 90-day mortality (adjusted odds ratio [aOR] 1.48, 95% confidence interval [CI] 1.11-1.98; p = 0.008), whereas 1-3 h, 3-6 h, and 6-12 h were not. In the continuous analysis restricted to patients who achieved target MAP within 24 h, TTT-MAP was not significantly associated with 90-day mortality per 1-h increase (aOR 1.025, 95% CI 0.972-1.082; p = 0.362). In Cox models, prolonged TTT-MAP (≥12 h or unreached) was associated with increased 90-day mortality versus early attainment (<12 h and reached) (adjusted hazard ratio [aHR] 3.24, 95% CI 2.19-4.80; p < 0.001). Conclusion: In this secondary analysis of the OPTPRESS trial, delayed attainment of the randomized lower-bound MAP target was associated with higher 90-day mortality. However, because TTT-MAP reflects time to first target attainment rather than the hypotension burden itself, these findings should not be interpreted as defining a clinically acceptable duration of hypotension or a threshold effect.
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