Septic Shock MAP Targets: Homogeneous Response, Heterogeneous Harm

link.springer.com October 7, 2025

This study, which analyzed 776 patients with septic shock, found that overall, there was no significant difference in the response (no heterogeneity) to different blood pressure targets, particularly concerning the primary outcome of 28-day mortality.

Despite the overall homogeneous effect, a deeper analysis revealed a critical nuance:

Risk of Harm: Targeting a higher Mean Arterial Pressure (MAP) may be associated with harm (higher mortality) if it required high doses of norepinephrine and/or did not resolve mottled skin by 24 hours.

Absence of Treatment Heterogeneity (HTE): The study found no evidence of significant HTE based on baseline patient characteristics (sweep p-value = 0.664).

Direct Effect: The direct effect of a higher MAP target on mortality was not significant (p=0.62). The increased mortality risk was specifically transmitted through the mediators of high norepinephrine doses and persistent mottling.