Persistent tissue hypoperfusion improves risk stratification beyond vasopressor dose in refractory septic shock: a secondary analysis of the ANDROMEDA-SHOCK-2 trial.
Intensive Care MedJul 15, 2026 (epub)
Eduardo Kattan, Gustavo A Ospina-Tascón, Nicolas Orozco et al.
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In 30 seconds
This secondary analysis of the ANDROMEDA-SHOCK-2 trial evaluated whether integrating persistent tissue hypoperfusion with vasopressor dose enhances mortality risk stratification in patients with refractory septic shock. Among 1363 patients, those meeting two-hypoperfusion criteria had a mortality rate of 73.6%, compared to 23.7% in non-refractory patients (aHR, 4.68; p < 0.001).
Key findings
- Among 1363 patients, 188 had NEE > 0.5 µg/kg/min at 6 hours, with a mortality rate of 47.9%.
- Patients meeting two-hypoperfusion criteria had a mortality rate of 73.6% compared to 23.7% in non-refractory patients (aHR, 4.68; p < 0.001).
- Under the ≥ 1-hypoperfusion criterion, mortality was 55.0% compared to 22.7% in non-refractory patients (aHR, 2.62; p < 0.001).
- The two-hypoperfusion construct provided superior prognostic enrichment for 28-day mortality (LR + , 8.12; p < 0.001).
Why it matters
Integrating persistent tissue hypoperfusion with vasopressor dose may enhance risk stratification in refractory septic shock, potentially guiding clinical decision-making and improving patient outcomes.