重症卒中患者最初24小时平均动脉压与临床结局的关联：MIMIC-III数据库分析
Association between Mean Arterial Pressure during the First 24 Hours and Clinical Outcome in Critically Ill Stroke Patients: An Analysis of the MIMIC-III Database.
作者信息
Zhang Sheng, Cui Yun-Liang, Yu Sheng, Shang Wei-Feng, Li Jie, Pan Xiao-Jun, Wen Zhen-Liang, Huang Si-Si, Chen Li-Min, Shen Xuan, Yu Yue-Tian, Liu Jiao, Chen De-Chang
机构信息
Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
Department of Critical Care Medicine, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan 250000, China.
出版信息
J Clin Med. 2023 Feb 16;12(4):1556. doi: 10.3390/jcm12041556.
Abnormal blood pressure is common in critically ill stroke patients. However, the association between mean arterial pressure (MAP) and mortality of critically ill stroke patients remains unclear. We extracted eligible acute stroke patients from the MIMIC-III database. The patients were divided into three groups: a low MAP group (MAP ≤ 70 mmHg), a normal MAP group (70 mmHg < MAP ≤ 90 mmHg), and a high MAP group (MAP > 90 mmHg). The Cox proportional hazards model and restricted cubic splines were used to assess the association between MAP and mortality. Sensitivity analyses were conducted to investigate whether MAP had different effects on mortality in different subpopulations. A total of 2885 stroke patients were included in this study. The crude 7-day and 28-day mortality was significantly higher in the low MAP group than that in the normal MAP group. By contrast, patients in the high MAP group did not have higher crude 7-day and 28-day mortality than those in the normal MAP group. After multiple adjustments using the Cox regression model, patients with low MAP were consistently associated with higher 7-day and 28-day mortality than those with normal MAP in the following subgroups: age > 60 years, male, those with or without hypertension, those without diabetes, and those without CHD ( < 0.05), but patients with high MAP were not necessarily associated with higher 7-day and 28-day mortality after adjustments (most > 0.05). Using the restricted cubic splines, an approximately L-shaped relationship was established between MAP and the 7-day and 28-day mortality in acute stroke patients. The findings were robust to multiple sensitivity analyses in stroke patients. In critically ill stroke patients, a low MAP significantly increased the 7-day and 28-day mortality, while a high MAP did not, suggesting that a low MAP is more harmful than a high MAP in critically ill stroke patients.
血压异常在重症中风患者中很常见。然而，重症中风患者的平均动脉压（MAP）与死亡率之间的关联仍不明确。我们从MIMIC-III数据库中提取了符合条件的急性中风患者。患者被分为三组：低MAP组（MAP≤70mmHg）、正常MAP组（70mmHg＜MAP≤90mmHg）和高MAP组（MAP＞90mmHg）。使用Cox比例风险模型和受限立方样条来评估MAP与死亡率之间的关联。进行敏感性分析以研究MAP在不同亚组中对死亡率是否有不同影响。本研究共纳入2885例中风患者。低MAP组的7天和28天粗死亡率显著高于正常MAP组。相比之下，高MAP组患者的7天和28天粗死亡率并不高于正常MAP组患者。在使用Cox回归模型进行多次调整后，在以下亚组中，低MAP患者与正常MAP患者相比，7天和28天死亡率持续较高：年龄＞60岁、男性、有或无高血压、无糖尿病、无冠心病（＜0.05），但调整后高MAP患者不一定与较高的7天和28天死亡率相关（大多数＞0.05）。使用受限立方样条，在急性中风患者的MAP与7天和28天死亡率之间建立了近似L形的关系。这些发现在中风患者的多次敏感性分析中具有稳健性。在重症中风患者中，低MAP显著增加7天和28天死亡率，而高MAP则不然，这表明在重症中风患者中，低MAP比高MAP更有害。
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