Department of Anesthesiology, Shenzhen People's Hospital, Shenzhen, China.
First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China.
Shock. 2021 Oct 1;56(4):557-563. doi: 10.1097/SHK.0000000000001774.
Studies have shown nonlinear relationships between systolic blood pressure (SBP) and outcomes, with increased risk observed at both low and high blood pressure levels. However, the relationships between cumulative times at different SBP levels and outcomes in critically ill patients remain unclear. We hypothesized that an appropriate SBP level is associated with a decrease in adverse outcomes after intensive care unit (ICU) admission.
This study was a retrospective analysis of data from the Medical Information Mart for Intensive Care (MIMIC) III database, which includes more than 1,000,000 SBP records from 12,820 patients. Associations of cumulative times at four SBP ranges (<100 mm Hg, 100-120 mm Hg, 120-140 mm Hg, and ≥140 mm Hg) with mortality (12-, 3-, 1-month mortality and in-hospital mortality) were evaluated. Restricted cubic splines and multivariable Cox regression models were employed to assess associations between mortality and cumulative times at SBP levels (4 levels: <2, 2-12, 12-36, and ≥36 h) over 72 h of ICU admission. Additionally, 120 mm Hg to 140 mm Hg was subdivided into <12 h (Group L) and ≥12 h (Group M) subsets and subjected to propensity-score matching and subgroup analyses.
At 120 mm Hg to 140 mm Hg, level-4 SBP was associated with lower adjusted risks of mortality at 12 months (OR, 0.71; CI, 0.61-0.81), 3 months (OR, 0.72; CI, 0.61-0.85), and 1 month (OR, 0.61; CI, 0.48-0.79) and in the hospital (OR, 0.71; CI, 0.58-0.88) than level-1 SBP. The cumulative times at the other 3 SBP ranges (<100 mm Hg, 100-120 mm Hg, and ≥140 mm Hg) were not independent risk predictors of prognosis. Furthermore, Group M had lower 12-month mortality than Group L, which remained in the propensity-score matched and subgroup analyses.
SBP at 120 mm Hg to 140 mm Hg was associated with decreased adverse outcomes. Randomized trials are required to determine whether the outcomes in critically ill patients improve with early maintenance of a SBP level at 120 mm Hg to 140 mm Hg.
研究表明，收缩压（SBP）与结局之间存在非线性关系，在低血压和高血压水平下均观察到风险增加。然而，危重病患者不同 SBP 水平的累积时间与结局之间的关系尚不清楚。我们假设适当的 SBP 水平与 ICU 入院后不良结局的减少有关。
本研究是对来自 Medical Information Mart for Intensive Care（MIMIC）III 数据库的数据的回顾性分析，该数据库包含来自 12820 名患者的超过 100 万份 SBP 记录。评估了四个 SBP 范围（<100mmHg、100-120mmHg、120-140mmHg 和≥140mmHg）的累积时间与死亡率（12 个月、3 个月、1 个月死亡率和住院死亡率）之间的关系。采用限制性立方样条和多变量 Cox 回归模型评估 ICU 入院后 72 小时内 SBP 水平（4 个水平：<2、2-12、12-36 和≥36h）的累积时间与死亡率之间的关系。此外，将 120mmHg 至 140mmHg 分为<12 小时（组 L）和≥12 小时（组 M）亚组，并进行倾向评分匹配和亚组分析。
在 120mmHg 至 140mmHg 水平，与 SBP 水平 1 相比，SBP 水平 4 的调整后 12 个月（OR，0.71；CI，0.61-0.81）、3 个月（OR，0.72；CI，0.61-0.85）和 1 个月（OR，0.61；CI，0.48-0.79）死亡率以及住院（OR，0.71；CI，0.58-0.88）的风险降低。其他 3 个 SBP 范围（<100mmHg、100-120mmHg 和≥140mmHg）的累积时间不是预后的独立危险因素。此外，与组 L 相比，组 M 的 12 个月死亡率较低，这在倾向评分匹配和亚组分析中仍然存在。
120mmHg 至 140mmHg 的 SBP 与不良结局减少相关。需要进行随机试验来确定危重病患者的结局是否通过早期维持 120mmHg 至 140mmHg 的 SBP 水平得到改善。
