平均动脉压波动对危重症患者死亡率的影响。

Impact of Mean Arterial Pressure Fluctuation on Mortality in Critically Ill Patients.

机构信息

Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.

National Engineering Laboratory for Integrated Aero-Space-Ground-Ocean Big Data Application Technology, School of Computer Science and Engineering, Northwestern Polytechnical University, Xi'an, China.

出版信息

Crit Care Med. 2018 Dec;46(12):e1167-e1174. doi: 10.1097/CCM.0000000000003435.

DOI:10.1097/CCM.0000000000003435

PMID:30247271

Abstract

OBJECTIVE

The purpose of this study was to investigate the association between mean arterial pressure fluctuations and mortality in critically ill patients admitted to the ICU.

DESIGN

Retrospective cohort.

SETTING

All adult ICUs at a tertiary care hospital.

PATIENTS

All adult patients with complete mean arterial pressure records were selected for analysis in the Multiparameter Intelligent Monitoring in Intensive Care II database. Patients in the external cohort were newly recruited adult patients in the Medical Information Mart for Intensive Care III database.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

The records of 8,242 patients were extracted. Mean arterial pressure fluctuation was calculated as follows: (mean nighttime mean arterial pressure - mean daytime mean arterial pressure)/mean arterial pressure. Patients were divided into two groups according to the degree of mean arterial pressure fluctuation: group A (between -5% and 5%) and group B (<-5% and >5%). The endpoints of this study were ICU and hospital mortality. Patients in group A (n = 4,793) had higher ICU and hospital mortality than those in group B (n = 3,449; 11.1% vs 8.1%, p < 0.001 and 13.8% vs 10.1%, p < 0.001, respectively). After adjusting for other covariates, the mean arterial pressure fluctuations between -5% and 5% were significantly correlated with ICU mortality (odds ratio, 1.296; 95% CI, 1.103-1.521; p = 0.002) and hospital mortality (odds ratio, 1.323; 95% CI, 1.142-1.531; p < 0.001). This relationship remained remarkable in patients with low or high Sequential Organ Failure Assessment scores in the sensitive analysis. Furthermore, external validation on a total of 4,502 individuals revealed that patients in group A still had significantly higher ICU (p < 0.001) and hospital mortality (p < 0.001) than those in group B.

CONCLUSIONS

The reduced mean arterial pressure fluctuation (within -5% and 5%) may be associated with ICU and hospital mortality in critically ill patients.

摘要

目的

本研究旨在探讨危重症患者 ICU 内平均动脉压波动与死亡率之间的关系。

设计

回顾性队列研究。

地点

一家三级医院的所有成人 ICU。

患者

从 Multiparameter Intelligent Monitoring in Intensive Care II 数据库中选择所有有完整平均动脉压记录的成年患者进行分析。外部队列的患者是从 Medical Information Mart for Intensive Care III 数据库中新招募的成年患者。

干预措施

无。

测量和主要结果

共提取了 8242 名患者的记录。平均动脉压波动的计算方法如下：（夜间平均动脉压均值-日间平均动脉压均值）/平均动脉压。根据平均动脉压波动程度将患者分为两组：A 组（-5%至 5%之间）和 B 组（<-5%和>5%）。本研究的终点为 ICU 死亡率和医院死亡率。A 组（n=4793）的 ICU 和医院死亡率均高于 B 组（n=3449；11.1%比 8.1%，p<0.001；13.8%比 10.1%，p<0.001）。在校正其他协变量后，-5%至 5%之间的平均动脉压波动与 ICU 死亡率（优势比，1.296；95%置信区间，1.103-1.521；p=0.002）和医院死亡率（优势比，1.323；95%置信区间，1.142-1.531；p<0.001）显著相关。在敏感分析中，对于 SOFA 评分较低或较高的患者，这种关系仍然显著。此外，对总共 4502 人的外部验证表明，A 组患者的 ICU 死亡率（p<0.001）和医院死亡率（p<0.001）仍显著高于 B 组。