Characterization and validation of a novel measure of septic shock severity

  • Nicholas A. BoschEmail author
  • Bijan Teja
  • Hannah Wunsch
  • Allan J. Walkey

Dear Editor,

In critical care, measures that normalize “dose” to physiological response (e.g., PaO2/FiO2 in Acute Respiratory Distress Syndrome) can improve mortality prediction and standardize syndrome definitions [1]. Normalized measures in septic shock—such as blood pressure response to vasopressor dose—are poorly studied, but may improve prognostication and identify patients who benefit from specific treatments. We sought to evaluate the prognostic validity of a novel measure of vasopressor responsiveness in septic shock analogous to PaO2/FiO2—the blood pressure to vasopressor dose ratio.

We conducted a retrospective study to validate blood pressure:vasopressor dose ratios using two cohorts of patients with septic shock within 24 h of ICU admission: the MIMIC-III [2] (2008–2012) and eICU Collaborative Research databases [3] (2014–2015). We determined mean arterial pressure (MAP) and norepinephrine equivalent doses (NEQ) [4] (modified with vasopressin 0.02–0.05...


Author contributions

NAB takes responsibility for the integrity of the work as a whole, from inception to published article. All authors substantially contributed to the conception and design of this study. NAB acquired the data. All authors were involved in the interpretation of data. NAB drafted the manuscript and all authors revised it critically for important intellectual content. All authors read and approved the final manuscript.


Financial/non-financial disclosures: the authors have reported the following: AJW is supported by the following NHLBI Grants: 5K01HL116768-03, 1R01HL136660-01. NAB is supported by the following NIH Grants: T32HL7035-42, 1F32GM133061-01.

Compliance with ethical standards

Conflicts of interest

Financial/non-financial disclosures: the authors have disclosed that they do not have any conflicts of interest.


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    Pollard TJ, Johnson AEW, Raffa JD et al (2018) The eICU collaborative research database, a freely available multi-center database for critical care research. Sci Data 5:180178CrossRefGoogle Scholar
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    Russell JA, Walley KR, Singer J et al (2008) Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med 358:877–887CrossRefGoogle Scholar
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    Yadav H, Harrison AM, Hanson AC et al (2015) Improving the accuracy of cardiovascular component of the sequential organ failure assessment score. Crit Care Med 43:1449–1457CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Medicine, The Pulmonary CenterBoston University School of MedicineBostonUSA
  2. 2.Interdisciplinary Division of Critical Care MedicineUniversity of TorontoTorontoCanada
  3. 3.Department of Critical Care MedicineSunnybrook Health Sciences CentreTorontoCanada
  4. 4.Department of Anesthesia and Interdisciplinary Division of Critical Care MedicineUniversity of TorontoTorontoCanada

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