Table 1.
General characteristics, hemodynamics, perfusion parameters, fluids, vasopressors, and outcomes for the propensity-matched cohort
| All | Very early-VPs (n = 93) | Delayed-VPs (n = 93) | p | |
|---|---|---|---|---|
| General characteristics | ||||
| Age, years | 64 (52–74) | 63 (51–74) | 65 (53–75) | 0.55 |
| Male sex, n (%) | ||||
| Weight, kg | 69 (58–77) | 70 (57–80) | 65 (59–72) | 0.08 |
| APACHE II | 16 (13–21) | 16 (13–19) | 16 (13–23) | 0.22 |
| SOFA day 1 | 9 (7–12) | 9 (8–12) | 10 (7–12) | 0.93 |
| Infection source, n (%) | ||||
| Lung | 60 (32.4) | 33 (35.9) | 27 (29.0) | 0.35 |
| Genitourinary | 33 (17.7) | 17 (18.3) | 16 (17.2) | 1.00 |
| Abdominal | 64 (34.4) | 29 (31.2) | 35 (37.6) | 0.44 |
| Soft tissue | 17 (9.1) | 9 (9.7) | 8 (8.6) | 1.00 |
| Bacteremia | 39 (21.0) | 17 (18.3) | 22 (23.7) | 0.47 |
| Other | 11 (5.9) | 7 (7.5) | 4 (4.3) | 0.54 |
| Origin | 0.56 | |||
| Emergency room | 135 (72.6) | 66 (71.0) | 69 (74.2) | |
| General ward | 24 (12.9) | 11 (11.8) | 13 (14.0) | |
| Intensive care unit | 27 (14.5) | 16 (17.2) | 11 (11.8) | |
| Comorbidities, n (%) | ||||
| Hypertension | 73 (39.2) | 34 (36.6) | 39 (41.9) | 0.55 |
| Coronary disease | 9 (4.8) | 4 (4.3) | 5 (5.4) | 1.00 |
| Chronic heart failure | 15 (8.1) | 7 (7.5) | 8 (8.6) | 1.00 |
| ESRF | 12 (6.5) | 5 (5.4) | 7 (7.5) | 0.77 |
| Previous stroke | 3 (1.6) | 3 (3.2) | 0 (0.0) | 0.25 |
| Chronic atrial fibrillation | 12 (6.5) | 12 (6.5) | 12 (6.5) | 1.00 |
| Diabetes | 36 (19.4) | 18 (19.4) | 18 (19.4) | 1.00 |
| Cancer | 38 (20.4) | 21 (22.6) | 17 (18.3) | 0.59 |
| COPD | 20 (10.8) | 14 (15.1) | 6 (6.5) | 0.10 |
| Chronic use steroids | 28 (15.1) | 9 (9.7) | 19 (20.4) | 0.06 |
| Cirrhosis | 12 (6.5) | 4 (4.3) | 8 (8.6) | 0.16 |
| Acute myocardial infarction | 3 (1.6) | 2 (2.2) | 1 (1.1) | 1.00 |
| Acute heart failure | 12 (6.5) | 8 (8.6) | 4 (4.3) | 0.37 |
| Acute stroke | 6 (3.2) | 2 (2.2) | 4 (4.3) | 0.68 |
| Acute atrial fibrillation | 9 (4.8) | 2 (2.2) | 7 (7.5) | 0.17 |
| Septic shock definition | 0.19 | |||
| Sepsis + VP + hyperlactatemia, n (%) | 127 (68.3) | 64 (68.8) | 63 (67.7) | |
| Sepsis + VP, n (%) | 59 (31.7) | 29 (31.2) | 30 (32.3) | |
| Supportive/rescue therapies | ||||
| Steroid use, n (%) | 114 (61.3) | 57 (61.3) | 57 (61.3) | 1.00 |
| Vasopressin use, n (%) | 63 (33.9) | 29 (31.2) | 34 (36.6) | 0.54 |
| Acute RRT | 35 (27.6) | 18 (28.1) | 17 (27.0) | 0.50 |
| Time intervals | ||||
| Up to VPs | ||||
| From first hypotension to VPs | 2 (0–4) | 1 (0–2) | 3 (2–5) | < 0.001 |
| From FRLoad to VPs | 0 (0–3) | 0 (0–1) | 3 (1–4) | < 0.001 |
| Up to ICU admission | ||||
| From VPs to ICU admission | 2 (0–4) | 1 (0–3) | 1 (0–4) | 0.87 |
| From first hypotension to ICU admission | 3 (1–4) | 3 (1–4) | 3 (2–4) | 0.91 |
| From FRLoad to ICU admission | 2 (0–4) | 2 (1–3) | 2 (1–3) | 0.78 |
| Up to antibiotic start | ||||
| From first hypotension to antibiotics | 2 (0–5) | 3 (1–5) | 1 (−3–5) | 0.04 |
| Hemodynamics, perfusion parameters | ||||
| At FRLoad | ||||
| SAP | 88 (78–98) | 89 (79–100) | 88 (77–97) | 0.61 |
| DAP | 47 (40–55) | 47 (41–55) | 47 (40–54) | 0.90 |
| MAP | 59 (54–65) | 59 (54–67) | 60 (55–66) | 0.74 |
| HR | 105 (90–118) | 103 (90–118) | 106 (90–118) | 0.73 |
| PP | 40 (30–53) | 41 (31–54) | 40 (30–50) | 0.73 |
| DSI | 2.26 (1.84–2.68) | 2.13 (1.81–2.56) | 2.12 (1.80–2.56) | 0.91 |
| At VPs | ||||
| SAP | 89 (82–102) | 92 (83–102) | 88 (82–100) | 0.22 |
| DAP | 48 (42–55) | 48 (41–54) | 48 (42–55) | 0.85 |
| MAP | 57 (55–66) | 57 (56–59) | 57 (55–59) | 0.57 |
| HR | 102 (87–118) | 100 (87–118) | 104 (89–117) | 0.73 |
| PP | 41 (32–53) | 43 (31–55) | 41 (34–50) | 0.56 |
| DSI | 2.17 (1.71–2.56) | 2.17 (1.70–2.62) | 2.17 (1.75–2.60) | 0.83 |
| pH arterial | 7.33 (7.26–7.39) | 7.32 (7.25–7.39) | 7.34 (7.26–7.39) | 0.50 |
| BE arterial | − 8.0 (− 11.9 to − 4.1) | − 7.8 (− 11.4 to − 3.9) | − 8.2 (−12.0 to − 4.2) | 0.43 |
| SvO2, %, n | 71.5 (64.5–79.5), 96 | 72.2 (62.8–80.5), 46 | 71.5 (68.0–78.5), 50 | 0.67 |
| Pv-aCO2, mmHg, n | 4.4 (3.5–6.4), 95 | 4.8 (3.8–6.1), 46 | 4.1 (3.5–6.4), 49 | 0.69 |
| PvaCO2/Da-vO2 ratio, n | 1.41 (1.01–1.98), 79 | 1.44 (1.01–1.93), 41 | 1.38 (1.02–2.14), 39 | 0.87 |
| Lactate initial, mmol/L, n | 2.4 (1.5–4.5), 186 | 2.4 (1.6–4.2), 93 | 2.6 (1.3–4.6), 93 | 0.84 |
| Lactate 6H, mmol/L | 2.0 (1.1–3.8), 186 | 1.9 (1.1–3.2), 93 | 2.1 (1.1–4.0), 93 | 0.55 |
| Lactate 24H, mmol/L, n | 1.7 (1.1–3.2), 158 | 1.6 (1.0–2.7), 80 | 1.9 (1.1–4.5), 78 | 0.04 |
| CVP at VP, mmHg, n | 7 (5–12), 29 | 11 (7–13), 11 | 6 (4–9), 18 | 0.09 |
| CVP at 6H, mmHg, n | 8 (5–12), 82 | 7 (5–12), 40 | 8 (5–12), 42 | 0.98 |
| CVP at 24H, mmHg, n | 8 (6–13), 107 | 8 (6–12), 52 | 10 (6–15), 55 | 0.28 |
| Fluids/VP/inotropics | ||||
| Cumulated volume of resuscitation fluids, mL | ||||
| FRLoad to VPs | 590 (0–1565) | 0 (0–500) | 1500 (650–2300) | < 0.001 |
| VPs to 2H | 1000 (450–1900) | 500 (200–1100) | 1700 (1000–2700) | < 0.001 |
| VPs to 4H | 1230 (500–2350) | 700 (300–1500) | 1800 (1000–2880) | < 0.001 |
| VPs to 6H | 1500 (750–2500) | 900 (500–1500) | 2000 (1400–3100) | < 0.001 |
| VPs to 8H | 1750 (900–3000) | 1100 (500–1900) | 2600 (1600–3800) | < 0.001 |
| Cumulated volume of resuscitation fluids, mL/kg | ||||
| FRLoad to VPs | 8.8 (0.0–25.0) | 0.0 (0.0–8.8) | 21.9 (9.0–37.0) | < 0.001 |
| VPs to 2H | 16.0 (6.3–30.0) | 7.3 (3.2–17.8) | 25.0 (15.1–41.8) | < 0.001 |
| VPs to 4H | 18.7 (8.1–33.3) | 10.0 (4.3–21.6) | 28.3 (17.1–45.4) | < 0.001 |
| VPs to 6H | 23.1 (10.0–38.5) | 12.5 (6.9–24.1) | 28.6 (21.9–50.0) | < 0.001 |
| VPs to 8H | 25.9 (12.5–44.5) | 16.7 (8.6–27.3) | 42.5 (24.3–58.1) | < 0.001 |
| Delta of resuscitation fluids, mL | ||||
| VPs to 2H | 175 (0–500) | 200 (0–500) | 0 (0–400) | 0.16 |
| 2H to 4H | 0 (0–300) | 0 (0–400) | 0 (0–300) | 0.92 |
| 4H to 6H | 0 (0–370) | 0 (0–300) | 0 (0–400) | 0.11 |
| 6H to 8H | 0 (0–500) | 0 (0–300) | 300 (0–630) | < 0.001 |
| Net fluid balance | ||||
| At FRLoad | 552 (0–2507) | 310 (0–1750) | 340 (0–2500) | 0.19 |
| At VPs | 1989 (661–3700) | 760 (10–2300) | 2090 (920–3260) | < 0.001 |
| At 6H | 2594 (1469–5055) | 1760 (1070–3410) | 2680 (1470–4480) | < 0.001 |
| At 24H | 4762 (3197–7049) | 3905 (2370–5100) | 5400 (3790–7290) | < 0.001 |
| Norepinephrine max. dose, μg/kg/min | 0.26 (0.13–0.48) | 0.26 (0.11–0.45) | 0.28 (0.15–0.53) | 0.32 |
| Dobutamine max. dose, μg/kg/min, n | 5.2 (3.0–10.2), 28 | 5.0 (3.7–7.0), 13 | 6.6 (3.0–11.6), 15 | 0.55 |
| Clinical outcomes | ||||
| LOS-ICU | 9 (5–17) | 9 (5–18) | 8 (4–17) | 0.30 |
| LOS-Hospital | 16 (7–32) | 17 (9–32) | 15 (6–30) | 0.11 |
| Mechanical ventilation-free days | 22 (0–28) | 23 (14–28) | 21 (0–26) | 0.03 |
| RRT-free days | 6 (0–18) | 8 (1–18) | 1 (0–13) | 0.26 |
| Mortality of 28 days, n (%) | 53 (28.5) | 17 (18.3) | 36 (38.7) | 0.03 |
APACHE II acute physiology and chronic health evaluation, SOFA sequential organ failure assessment, CHF cardiac heart failure, ESRF end-stage renal failure, COPD chronic obstructive pulmonary disease, VP vasopressor, VPs vasopressor start, FRLoad first fluid load with resuscitative intention, SAP systolic arterial pressure, DAP diastolic arterial pressure, MAP mean arterial pressure, HR heart rate, PP pulse pressure, DSI diastolic shock index (HR to DAP ratio), BE base excess, SvO2 oxygen venous saturation, Pv-aCO2 venous-to-arterial carbon dioxide difference, PvaCO2/Da-vO2 ratio venous-arterial carbon dioxide to arterial-venous oxygen differences ratio, CVP central venous pressure, LOS-ICU intensive care unit - length of stay, LOS-Hospital hospital - length of stay, RRT renal replacement therapy
*Including only patients receiving renal replacement therapy at least for one session