Shengli Clinical Medical College of Fujian Medical University, China.
Medical Intensive Care Unit of Fujian Provincial Hospital, China.
Clin Appl Thromb Hemost. 2020 Jan-Dec;26:1076029620933944. doi: 10.1177/1076029620933944.
We aimed to determine whether the average mean arterial pressure (aMAP) in the first 24 hours of hospital admission is useful in predicting short-term outcomes of patients with intermediate- and high-risk pulmonary embolism (PE). We conducted a single-center retrospective study. From May 2012 to April 2019, 122 patients with intermediate- and high-risk PE were included. The primary outcome was in-hospital mortality. The secondary outcome was adverse events. Receiver operating characteristic (ROC) curves and cutoff values for aMAP predicting in-hospital death were computed. According to cutoff values, we categorized 5 groups defined as follows: group 1: aMAP < 70 mm Hg; group 2: 70 mm Hg ≤ aMAP < 80 mm Hg; group 3: 80 mm Hg ≤ aMAP < 90 mm Hg; group 4: 90 mm Hg ≤ aMAP <100 mm Hg; and group 5: aMAP ≥ 100 mm Hg. Cox regression models were calculated to investigate associations between aMAP and in-hospital death. In the study group of 122 patients, 15 (12.30%) patients died in the hospital due to PE. The ROC analysis for MAP predicting in-hospital death revealed an area under the curve of 0.729 with a cutoff value of 79.4 mm Hg. Cox regression models showed a significant association between in-hospital death and aMAP group 1 (ref), aMAP group 2 (odds ratio [OR] = 1.680, 95% CI: 0.020-140.335), aMAP group 3 (OR = 0.003, 95% CI: 0.0001-0.343), aMAP group 4 (OR = 0.006, 95% CI: 0.0001-1.671), and aMAP group 5 (OR = 0.003, 95% CI: 0.0001-9.744). In particular, those with an aMAP of 80 to 90 mm Hg had minimum adverse events. The optimal range of MAP for patients with intermediate- and high-risk PE may be 80 to 90 mm Hg.
我们旨在确定入院后 24 小时内平均动脉压（aMAP）是否可用于预测中高危肺栓塞（PE）患者的短期预后。我们进行了一项单中心回顾性研究。2012 年 5 月至 2019 年 4 月，纳入 122 例中高危 PE 患者。主要结局为院内死亡率。次要结局为不良事件。计算了 aMAP 预测院内死亡的受试者工作特征（ROC）曲线和截断值。根据截断值，我们将 5 组分为以下几类：组 1：aMAP<70mmHg；组 2：70mmHg≤aMAP<80mmHg；组 3：80mmHg≤aMAP<90mmHg；组 4：90mmHg≤aMAP<100mmHg；组 5：aMAP≥100mmHg。计算 Cox 回归模型以探讨 aMAP 与院内死亡之间的关系。在 122 例研究患者中，15 例（12.30%）患者因 PE 而死亡。MAP 预测院内死亡的 ROC 分析显示曲线下面积为 0.729，截断值为 79.4mmHg。Cox 回归模型显示，院内死亡与 aMAP 组 1（参考）、aMAP 组 2（比值比[OR] = 1.680，95%CI：0.020-140.335）、aMAP 组 3（OR = 0.003，95%CI：0.0001-0.343）、aMAP 组 4（OR = 0.006，95%CI：0.0001-1.671）和 aMAP 组 5（OR = 0.003，95%CI：0.0001-9.744）之间存在显著关联。特别是，MAP 为 80-90mmHg 的患者不良事件最少。中高危 PE 患者 MAP 的最佳范围可能为 80-90mmHg。
