Anesthesia Department, Erasme University Hospital, Lennik street 808, B-1070 Brussels, Belgium.
Emergency Department, Erasme University Hospital, Lennik street 808, B-1070 Brussels, Belgium.
Am J Emerg Med. 2019 Dec;37(12):2242-2245. doi: 10.1016/j.ajem.2019.158360. Epub 2019 Jul 23.
Hypotension, defined as a mean arterial pressure of maximum 70 mmHg, is associated with significant morbidity and mortality. The objective of this study was to determine in initially non-critical hypotensive adult patients the proportion of sepsis and if septic patients had different outcome and clinical factors than non-septic patients.
This retrospective observational study was conducted over a year on adult hypotensive emergency department patients initially considered by triage as non-critical. Patients were separated into three groups: hypotensive septic patients (HSP), hypotensive non-septic infected patients (HNSIP), and other hypotensive patients (OHP). Clinical scores, signs, length of stay (LOS), and mortality were compared using analysis of variance for continuous variables and chi-square analysis for categorical variables.
There were 136 (35.5%) septic patients, 37 (9.7%) with non-septic infection, and 210 (54.8%) with another cause of hypotension. Overall in-hospital mortality was 12.0% and total mortality was greater in HSP than in HNSIP (20.6% vs. 5.4%, p = 0.031) or OHP (20.6 vs. 7.6%, p < 0.001). LOS was greater for HSP when compared to HNSIP (median(IQR): 9(6-17) vs. 6(1-13), p = 0.004) and OHP (median(IQR): 9(6-17) vs. 3(1-8) days, p < 0.0001).
Sepsis in a priori non-critical hypotensive adult patients, when compared with other causes of hypotension, is associated with significantly higher mortality and increased LOS. Patients that present to the emergency department and have a MAP of 70mmHg or less must be rigorously evaluated and have consistent follow-up.
血压降低，定义为平均动脉压最大 70mmHg，与显著的发病率和死亡率相关。本研究的目的是确定最初非危急低血压的成年患者中脓毒症的比例，以及脓毒症患者与非脓毒症患者的不同结局和临床因素。
这是一项回顾性观察性研究，在一年内在最初被分诊为非危急的低血压急诊患者中进行。患者被分为三组：低血压性脓毒症患者（HSP）、低血压性非感染性感染患者（HNSIP）和其他低血压患者（OHP）。使用方差分析比较连续变量，使用卡方分析比较分类变量，比较临床评分、体征、住院时间（LOS）和死亡率。
共有 136 例（35.5%）脓毒症患者，37 例（9.7%）非感染性感染，210 例（54.8%）有其他原因导致低血压。总住院死亡率为 12.0%，HSP 的总死亡率高于 HNSIP（20.6%比 5.4%，p=0.031）或 OHP（20.6%比 7.6%，p<0.001）。与 HNSIP 相比，HSP 的 LOS 更长（中位数（IQR）：9（6-17）比 6（1-13），p=0.004）和 OHP（中位数（IQR）：9（6-17）比 3（1-8）天，p<0.0001）。
与其他低血压原因相比，预先存在的非危急低血压成年患者中的脓毒症与显著更高的死亡率和延长的 LOS 相关。到急诊科就诊且平均动脉压为 70mmHg 或更低的患者必须进行严格评估并进行持续随访。
