Introduction: Early administration of vasopressors in septic shock may improve survival, but not all patients derive equal benefit. We aimed to develop a prognostic model to identify patients who are more likely to survive with early vasopressor therapy. Methods: We analyzed data from a prospective multicenter cohort of adult patients with sepsis admitted to Korean hospitals between September 2019 and May 2023. Of 17,828 sepsis patients, 3,064 had septic shock. Early vasopressor use was defined as initiation within 1 hour after adequate fluid resuscitation. We excluded patients who did not receive fluid loading (n=275), did not receive vasopressors (n=20), received vasopressors prior to fluid loading (n=417), or received vasopressors more than 1 hour after fluid resuscitation (n=353). The final cohort included 1,999 patients who received early vasopressor therapy following fluid loading. Results: Among these patients, 1,259 survived and 740 died within 28 days. Using forward selection, 14 variables were identified as significantly associated with 28-day survival: initial lactate level, clinical frailty score, chronic neurologic disease, blood urea nitrogen, SOFA-pF score, Charlson comorbidity index, body mass index, hematocrit, urinary tract infection, age, brain natriuretic peptide, aspartate aminotransferase, C-reactive protein, and SOFA-cardiovascular score. A survival prediction model was developed and internally validated using a 7:3 split into training and validation datasets. The model demonstrated good discriminative performance, with an area under the receiver operating characteristic curve (AUC) of 0.781 in the training set and 0.798 in the validation set. Conclusions: We developed a clinically applicable prediction model to identify septic shock patients who are most likely to benefit from early vasopressor therapy. This tool may support individualized decision-making during the early phase of sepsis management.
Choi et al. (Sun,) studied this question.