Association Between Early Arterial Catheterization and Prognosis in Patients with Septic Shock: A Retrospective Propensity Score Analysis

Background Arterial catheterization serves as a cornerstone monitoring modality in septic shock management, enabling continuous hemodynamic assessment and serial blood gas analysis. Despite its widespread use, mortality benefits and optimal timing for catheter insertion remains undefined. Methods An analysis of clinical data from 6,485 critically ill adult patients, identified as meeting the Sepsis-3 criteria for septic shock, was conducted utilizing the MIMIC-IV database. Through entropy-balanced propensity score matching (PSM, 1:1 ratio) and doubly robust estimation with inverse probability weighting, we compared outcomes between catheterized (≤24 h post-admission) and non-catheterized groups. Restricted cubic spline (RCS) modeling characterized nonlinear temporal associations. The evaluation encompassed both primary and secondary endpoints, including 28-day mortality, mortality within the ICU and hospital settings, length of stay, CRRT requirements, and physiological resuscitation metrics. Results After PSM (1,416 patients from initial 6,485) with 1:1 ratio, arterial catheterization exhibited significantly reduced mortality across all measured outcomes compared to non-catheterized controls: 28-day mortality (26.1% vs 43.9%; aHR 0.62, 95%CI 0.51-0.75), ICU mortality (aHR 0.76, 0.61-0.94), and in-hospital mortality (HR 0.70, 0.58-0.86), all P < .05. Arterial catheterization was associated with a shorten ICU stay by 0.52 days (95%CI 0.18-0.82, P = .002) and improved physiological parameters. Restricted cubic splines identified optimal intervention timing at 204–290 min post-admission through U-shaped mortality risk association. Conclusion In a cohort of critically ill patients with septic shock, early peripheral arterial catheterization is significantly associated with improved 28-day mortality outcomes.