In-hospital mortality continued to rise as admission-shock-onset-time increased in patients with septic shock. No clear dichotomization between early and late septic shock could be ascertained, and this categorization may limit our understanding of the temporal relationship of shock onset to mortality.

2,520 patients met the inclusion criteria with an overall in-hospital mortality of 37.3%.

The log-transformed admission-shock-onset-time was associated with higher in-hospital and ICU mortality even after adjusting for clinical variables.

The odds ratio (OR) for in-hospital mortality continued to increase throughout the observation period.

The adjusted OR exceeded 2 in-between 20.1 hours and 54.6 hours, and it surpassed 3 in-between 54.6 hours and 148.4 hours of the time from the hospital admission to shock onset.

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