Tang Yi, Sorenson Jeff, Lanspa Michael, Grissom Colin K, Mathews V J, Brown Samuel M
Electrical and Computer Engineering, University of Utah, 50 Central Campus Dr #2110, Salt Lake City, UT, 84112, USA.
Pulmonary and Critical Care, Intermountain Medical Center, 5121 Cottonwood St, Murray, UT, 84107, USA.
BMC Anesthesiol. 2017 Jun 17;17(1):82. doi: 10.1186/s12871-017-0377-4.
Severe sepsis and septic shock are often lethal syndromes, in which the autonomic nervous system may fail to maintain adequate blood pressure. Heart rate variability has been associated with outcomes in sepsis. Whether systolic blood pressure (SBP) variability is associated with clinical outcomes in septic patients is unknown. The propose of this study is to determine whether variability in SBP correlates with vasopressor independence and mortality among septic patients.
We prospectively studied patients with severe sepsis or septic shock, admitted to an intensive care unit (ICU) with an arterial catheter. We analyzed SBP variability on the first 5-min window immediately following ICU admission. We performed principal component analysis of multidimensional complexity, and used the first principal component (PC) as input for Firth logistic regression, controlling for mean systolic pressure (SBP) in the primary analyses, and Acute Physiology and Chronic Health Evaluation (APACHE) II score or NEE dose in the ancillary analyses. Prespecified outcomes were vasopressor independence at 24 h (primary), and 28-day mortality (secondary).
We studied 51 patients, 51% of whom achieved vasopressor independence at 24 h. Ten percent died at 28 days. PC represented 26% of the variance in complexity measures. PC was not associated with vasopressor independence on Firth logistic regression (OR 1.04; 95% CI: 0.93-1.16; p = 0.54), but was associated with 28-day mortality (OR 1.16, 95% CI: 1.01-1.35, p = 0.040).
Early SBP variability appears to be associated with 28-day mortality in patients with severe sepsis and septic shock.
严重脓毒症和脓毒性休克通常是致死性综合征，其中自主神经系统可能无法维持足够的血压。心率变异性与脓毒症的预后相关。收缩压（SBP）变异性是否与脓毒症患者的临床预后相关尚不清楚。本研究的目的是确定SBP变异性是否与脓毒症患者停用血管升压药及死亡率相关。
我们对入住重症监护病房（ICU）并留置动脉导管的严重脓毒症或脓毒性休克患者进行了前瞻性研究。我们分析了ICU入院后立即出现的首个5分钟时间段内的SBP变异性。我们对多维复杂性进行主成分分析，并将第一主成分（PC）作为Firth逻辑回归的输入，在主要分析中控制平均收缩压（SBP），在辅助分析中控制急性生理与慢性健康状况评价系统（APACHE）II评分或去甲肾上腺素剂量。预先设定的结局为24小时内停用血管升压药（主要结局）和28天死亡率（次要结局）。
我们研究了51例患者，其中51%在24小时内停用了血管升压药。10%在28天时死亡。PC占复杂性测量指标方差的26%。在Firth逻辑回归中，PC与停用血管升压药无关（比值比1.04；95%置信区间：0.93 - 1.16；p = 0.54），但与28天死亡率相关（比值比1.16，95%置信区间：1.01 - 1.35，p = 0.040）。
早期SBP变异性似乎与严重脓毒症和脓毒性休克患者的28天死亡率相关。
