This retrospective study examined corticosteroid timing in adults with vasopressor-treated septic shock across three ICU cohorts, identifying deteriorated and improved phenotypes from 168-hour haemodynamic trajectories. Early administration was defined as within six hours of sepsis onset, versus later administration. In the MIMIC-IV deteriorated phenotype, late corticosteroids were associated with lower 28-day mortality (HR 0.88 [0.78–0.98]) and shorter ventilation duration (HR 0.65 [0.58–0.73]). The mortality association was not consistently replicated in validation cohorts; the improved phenotype showed no consistent mortality or hospital length-of-stay association with later treatment.
Haemodynamic trajectories may identify heterogeneity in associations between corticosteroid timing and septic-shock outcomes. These observational findings do not establish a benefit from delaying corticosteroids.
Study limitation: Retrospective treatment comparisons remain vulnerable to confounding, and the mortality association was not consistently replicated across validation cohorts.
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