Highlight
– Refractory septic shock defined by high vasopressor dose plus persistent tissue hypoperfusion predicts markedly higher 28-day mortality compared to vasopressor dose alone.
– Combining capillary refill time and lactate trends with norepinephrine equivalent dose at 6 hours improves prognostic accuracy.
– Patients meeting both tissue hypoperfusion criteria had a 73.6% mortality rate, significantly exceeding that of patients classified by vasopressor dose alone.
– This biomarker-integrated risk stratification may guide early aggressive interventions and clinical trial enrichment.
