Abstract
BACKGROUND AND AIMS: We performed this systematic review and meta-analysis to study the timing of vasopressin initiation and its association with patient-centered outcomes in adult patients with septic shock. DATA SOURCES AND STUDY SELECTION: We searched Embase, PubMed, and Web of Science for eligible prospective, retrospective studies, and Randomized controlled trials (RCTs) from January 2013 to December 2024 in adult patients with septic shock that compared an early (<6 hours) vs late strategy (>6 hours) of vasopressin initiation. Our primary outcome was short-term mortality, while other secondary outcomes included hospital and ICU mortality, incidence of renal replacement therapy (RRT), occurrence of new-onset arrhythmias (NOA), and ICU and hospital length of stay (LOS). RESULTS: Seven studies with a total of 3,993 patients were included in the systematic review and meta-analysis. Early initiation of vasopressin was associated with a lower short-term mortality [relative risk (RR) 0.84, 95% CI: 0.71-0.99; p = 0.033, I (2) = 30.2%], which was the primary outcome of our study. Early vasopressin initiation was associated with a decrease in hospital mortality (RR 0.83, 95% CI: 0.76-0.92; p = 0.0003, I (2) = 17.9%), decreased requirement of RRT (RR 0.78, 95% CI: 0.61-0.99, p = 0.043, I (2) = 31%), decreased ICU mortality (RR 0.86, 95% CI: 0.78-0.95; p = 0.003, I (2) = 0%) and hospital LOS) [mean difference (MD) -1.83 (-3.41 to -0.25) days, p = 0.02]. There was no difference in new-onset arrhythmia or length of ICU stay between the two groups. CONCLUSION: We report a significant advantage of initiating vasopressin within six hours for patients experiencing septic shock. However, the studies contributing to this meta-analysis are characterized as being at high risk of bias. HOW TO CITE THIS ARTICLE: Bhattacharjee A, Datta PK, Kumar V, Ravikumar RH, Sathe P, Kundu R. Timing of Vasopressin Initiation in Patients with Septic Shock: An Updated Systematic Review and Meta-analysis with Trial Sequential Analysis. Indian J Crit Care Med 2025;29(10):839-850.