Association Between Vasopressor Discontinuation Sequence and Clinical Outcomes in Septic Shock: Norepinephrine Versus Vasopressin in the MIMIC-IV Database

Background/Objectives: The optimal order in which to withdraw norepinephrine (NE) and vasopressin (VP) when weaning vasopressor support in septic shock is uncertain. We compared clinical outcomes between NE-first and VP-first discontinuation.

Methods

This retrospective cohort study used MIMIC-IV version 3.1 (2008–2022). We included adults with septic shock receiving concurrent NE and VP who underwent sequential discontinuation, with the remaining agent continued for at least 60 min. The primary outcome was 28-day all-cause mortality. Firth-penalized logistic regression was adjusted for age, sex, first-day Sequential Organ Failure Assessment (SOFA) score, and peri-overlap lactate. Additional models incorporated pre-discontinuation measurements.