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Age-Comorbidity Interactions and Clinical Outcomes in Septic Shock: An Emergency Department-Based Multicenter Cohort Study

2026-03-01T00:00:00Z

Title: Age-Comorbidity Interactions and Clinical Outcomes in Septic Shock: An Emergency Department-Based Multicenter Cohort Study Authors: Maeng, Seung Jin; Park, Jong Eun; Lee, Gun Tak; Hwang, Sung Yeon; Kim, Minha; Heo, Sejin; Lim, Tae Ho; Chung, Sung Phil; Choi, Sung-Hyuk; Shin, Tae Gun Abstract: Background: Sepsis remains a leading cause of mortality worldwide. This study evaluated the independent and combined effects of age and chronic comorbidities on clinical outcomes in patients with septic shock. Methods: We conducted a multicenter retrospective observational study to evaluate the factors associated with 28-day mortality in the Korean Shock Society registry between 2015 and 2023. Adults with suspected infection and refractory hypotension or hypoperfusion within 6 h of emergency department (ED) arrival were included. Patients were grouped by age (<50, 50-74, and >= 75 years) and comorbidity status. Comorbidities encompass major chronic conditions including hypertension, diabetes mellitus, malignancy, history of organ transplant, dementia, nursing home residence, chronic disease of cardiac, lung, liver, and kidney. The primary outcome was 28-day mortality. Multivariable logistic regression analysis was used. Results: Among 8787 patients (median age 70.2 years), the 28-day mortality rate was 22.9% (n = 2018). Elderly patients with comorbidities had the highest mortality (27.5%). Additionally, patients aged over 50 with at least one comorbidity accounted for 18% of the total cohort (n = 1605) but accounted for nearly 80% of all 28-day deaths. Although younger patients without comorbidities represented a small subgroup, their mortality was not negligible (7.3%) and was substantially higher with comorbidities (22.2%). Compared with patients <50 years, adjusted odds ratios (aORs) of 28-day mortality were 1.81 (95% CI, 1.08-3.03) for 50-74 years and 3.21 (95% CI, 1.92-5.37) for >= 75. The presence of any comorbidities was independently associated with higher odds of 28-day mortality compared with no comorbidity (aOR 2.67; 95% CI, 1.57-4.54). A significant interaction between age and comorbidity status (p for interaction = 0.008) suggested that the age-related gradient in mortality differed depending on comorbidity burden. Conclusions: Age and comorbidities were both significantly associated with septic shock mortality, and their significant interaction demonstrates effect modification, indicating that the prognostic impact of comorbidities differs by age group and that age-related mortality gradients are influenced by comorbidity burden.

Diagnostic performance of a video-assisted cardiac arrest recognition protocol by emergency medical dispatcher in out-of-hospital cardiac arrest

2026-02-01T00:00:00Z

Title: Diagnostic performance of a video-assisted cardiac arrest recognition protocol by emergency medical dispatcher in out-of-hospital cardiac arrest Authors: Lee, Stephen Gyung Won; Kim, Tae Han; Choi, Dong Hyun; Kim, Min Woo; Hong, Ki Jeong; Ro, Young Sun; Song, Kyoung Jun; Shin, Sang Do Abstract: Introduction: Cardiac arrest recognition by emergency medical dispatch (EMD) is essential for initiation of telephone CPR that could lead to bystander CPR before emergency medical service (EMS) arrival. Video-assisted cardiac arrest recognition protocol was developed and implemented for better recognition of cardiac arrest suspected calls that recognition was uncertain under conventional audio-call dispatch. We tested the performance of video-assisted protocol after pilot implementation in a metropolitan dispatch center. Methods: All emergency medical dispatch calls received by Seoul emergency dispatch center that used video-assisted cardiac arrest recognition protocol from June 2020 to December 2020 were enrolled. The primary outcome was the presence of cardiac arrest upon EMS arrival evaluated by EMS providers arrived at the scene. The predictive performance measure of video-assisted protocol was calculated including sensitivity and speciResult: During the study period, video-assisted protocol was used in 115 emergency calls that dispatchers were uncertain based on the initial audio call. In 15 cases the dispatcher additionally recognized the case as cardiac arrest under video-assistance. Of recognized cases, 14 (93.3 %) cases were confirmed as cardiac arrest upon EMS arrival. The sensitivity (95 % CI) and the specificity (95 % CI) of the video-assisted protocol were 66.7 % (43.0-85.4) and 98.9 % (94.2-100) respectively. Conclusion: Use of video-assisted cardiac arrest recognition protocol helped recognize additional cardiac arrest cases that could not be recognized with the audio-call in the dispatch center. Technological and operational improvement should be continuously studied for better cardiac arrest recognition using video-assisted protocol during emergency call taking.

Impact of Violations of the Shortest Distance-Based Transport Protocol for Intra-Arrest on Clinical Outcomes in a Metropolitan City: A Large-Scale Registry Study

2026-02-01T00:00:00Z

Title: Impact of Violations of the Shortest Distance-Based Transport Protocol for Intra-Arrest on Clinical Outcomes in a Metropolitan City: A Large-Scale Registry Study Authors: Choi, Ju Hwan; Choi, Arom; Yoon, Hanna; Park, Chaeryoung; Jeon, Soyoung; Lee, Eunju; Kim, Ji Hoon Abstract: Background/Objective: The optimal strategy for hospital transport of patients with out-of-hospital cardiac arrest is unclear. A transport protocol based on the shortest travel route was implemented in a metropolitan area in the Republic of Korea to minimize prehospital transport time; however, the protocol is frequently violated. This study evaluated whether protocol violations influenced the clinical outcomes of patients who experienced intra-arrest. Methods: This retrospective observational study included patients who experienced out-of-hospital cardiac arrest and were transported by emergency medical services between September 2021 and December 2022. We analyzed run sheets, the cardiac arrest registry, and Out-of-Hospital Cardiac Arrest Surveillance data, which contain patient demographics, time variables, Utstein factors, posthospital arrival treatments, and clinical outcomes. The primary outcome was emergency department mortality. The secondary outcome was poor neurological outcome (cerebral performance category scores 3-5). Logistic regression and mediation analyses assessed associations between protocol violations, transport times, and clinical outcomes. Results: Among the 3474 cardiac arrest cases, 1534 (44.2%) had transport protocol violations. Violations were associated with longer scene and transfer times. The emergency department survival rates for the protocol-violation and -nonviolation groups were 15.4% and 16.4%, respectively. Protocol violations were not associated with mortality (odds ratio [OR]: 1.04; 95% confidence interval [CI] 0.85-1.27, p = 0.70) or poor neurological outcomes (OR: 1.00; 95% CI 0.45-2.18, p = 0.99). Mediation analysis revealed that increased transfer time did not affect clinical outcomes. Conclusions: These results suggest that transport strategies should consider real-time availability of emergency resources and adopt an evidence-based approach.

Effect of norepinephrine initiation timing on mortality in septic shock: a multicenter cohort study

2026-01-01T00:00:00Z

Title: Effect of norepinephrine initiation timing on mortality in septic shock: a multicenter cohort study Authors: Choi, Jung Won; Shin, Tae Gun; Maeng, Seung Jin; Hwang, Sung Yeon; Kim, Sang-Min; Kim, Won Young; Kim, Kyuseok; Park, Sung-Joon; Choi, Sung-Hyuk; Ahn, Sejoong; Kwon, Woon Yong; Kong, Taeyoung; Chung, Sung Phil; Ko, Byuk Sung; Lim, Tae Ho Abstract: Background: This study aims to investigate the association between timing of norepinephrine (NE) initiation and mortality in septic shock. Methods: We conducted a retrospective study using data from a multicenter database. Adult patients with septic shock presenting to the emergency departments, who showed initial hypotension and received NE, were included. We performed multivariable regression analysis to evaluate the association between norepinephrine timing and 28-day mortality, with stratifying according to the Sepsis-3 shock definition and vasopressor requirement risk assessed by the diastolic shock index and lactate levels. Results: A total of 4,456 patients were included. In the non-Sepsis-3 shock group, no significant association was found between the timing of NE administration and 28-day mortality. However, in the Sepsis-3 shock group, a significant association was observed, with each hourly delay in NE administration increasing the risk of 28-day mortality (aOR for hourly delay: 1.07, 95% CI: 1.02-1.13, P = 0.002). Compared to the > 6-hour group, the aOR for 28-day high vasopressor requirement risk. mortality was 0.54 (95% CI: 0.35-0.81, P = 0.003) for norepinephrine administration within 1 h and 0.63 (95% CI: 0.42-0.95, P = 0.025) for the 1-3 h group. In the high-vasopressor requirement risk, hourly delay in NE administration was also associated with an increased risk of 28-day mortality (aOR for hourly delay: 1.07, 95% CI: 1.00-1.13, P = 0.027). Compared to the > 6-hour group, the aOR for 28-day mortality was 0.53 (95% CI: 0.33-0.86, P = 0.010) for within 1 h group. Conclusions: Early NE administration was associated with decreased 28-day mortality in patients who met the Sepsis-3 septic shock criteria and who had high vasopressor requirement risk.