非创伤性蛛网膜下腔出血患者基线脉压与医院死亡率之间的关联：一项回顾性队列研究。
Association between baseline pulse pressure and hospital mortality in non-traumatic subarachnoid hemorrhage patients: a retrospective cohort study.
作者信息
Liu Jiuling, Wang Shu, Ji Lin, Wang Xiaoqing, Zhao Hang
机构信息
Department of Neurology, Nanjing BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China.
Department of Anesthesiology, The Yancheng School of Clinical Medicine of Nanjing Medical University (Yancheng Third People's Hospital), Yancheng, Jiangsu Province, China.
出版信息
Front Neurol. 2023 Jul 17;14:1176546. doi: 10.3389/fneur.2023.1176546. eCollection 2023.
BACKGROUND AND PURPOSE
Previous studies have described an association between pulse pressure (PP) level and mortality in stroke patients. Evidence of associations between PP level and the risk of mortality remains unknown in non-traumatic subarachnoid hemorrhage (SAH) patients. We aimed to explore the relationship between the baseline PP level and hospital mortality.
METHODS
This cohort study of 693 non-traumatic SAH adults used Medical Information Mart for Intensive Care (MIMIC-IV) data from 2008-2019 admissions to Intensive Care Unit (ICU). PP level was calculated as the first value after admission to the ICU. The endpoint of the study was in-hospital mortality. Cox proportional hazards models were utilized to analyze the association between baseline PP level and hospital mortality. Restricted Cubic Splines (RCS) analysis was utilized to determine the relationship curve between hospital mortality and PP level and examine the threshold saturation effect. We further applied Kaplan-Meier survival curve analysis to examine the consistency of these correlations. The interaction test was used to identify subgroups with differences.
RESULTS
The mean age of the study population was 58.8 ± 14.6 years, and 304 (43.9%) of participants were female. When baseline PP level was assessed in quartiles, compared to the reference group (Q1 ≤ 56 mmHg), the adjusted hazard ratio (HR) in Q2 (57-68 mmHg), Q3(69-82 mmHg), Q4 (≥83 mmHg) were 0.55 (95% CI: 0.33-0.93, = 0.026), 0.99 (95% CI, 0.62-1.59, = 0.966), and 0.99 (95% CI: 0.62-1.59, = 0.954), respectively. In the threshold analysis, for every 5 mmHg increase in PP level, there was an 18.2% decrease in hospital mortality (adjusted HR, 0.818; 95% CI, 0.738-0.907; = 0.0001) in those with PP level less than 60 mmHg, and a 7.7% increase in hospital mortality (adjusted HR, 1.077; 95% CI, 1.018-1.139; = 0.0096) in those with PP level was 60 mmHg or higher.
CONCLUSION
For patients with non-traumatic SAH, the association between baseline PP and risk of hospital mortality was non-linear, with an inflection point at 60 mmHg and a minimal risk at 57 to 68 mmHg (Q2) of baseline PP level.
背景与目的
既往研究描述了脉压（PP）水平与卒中患者死亡率之间的关联。PP水平与非创伤性蛛网膜下腔出血（SAH）患者死亡风险之间的关联证据尚不清楚。我们旨在探讨基线PP水平与医院死亡率之间的关系。
方法
这项队列研究纳入了693例非创伤性SAH成年患者，使用了重症监护医疗信息数据库（MIMIC-IV）中2008年至2019年入住重症监护病房（ICU）患者的数据。PP水平计算为入住ICU后的首个值。研究终点为院内死亡率。采用Cox比例风险模型分析基线PP水平与医院死亡率之间的关联。使用受限立方样条（RCS）分析来确定医院死亡率与PP水平之间的关系曲线，并检验阈值饱和效应。我们进一步应用Kaplan-Meier生存曲线分析来检验这些相关性的一致性。采用交互检验来识别存在差异的亚组。
结果
研究人群的平均年龄为58.8±14.6岁，304例（43.9%）参与者为女性。当按四分位数评估基线PP水平时，与参照组（Q1≤56mmHg）相比，Q2（57 - 68mmHg）、Q3（69 - 82mmHg）、Q4（≥83mmHg）的调整后风险比（HR）分别为0.55（95%CI：0.33 - 0.93，P = 0.026）、0.99（95%CI，0.62 - 1.59，P = 0.966）和0.99（95%CI：0.62 - 1.59，P = 0.954）。在阈值分析中，对于PP水平低于60mmHg的患者，PP水平每升高5mmHg，医院死亡率降低18.2%（调整后HR，0.818；95%CI，0.738 - 0.907；P = 0.0001）；对于PP水平为60mmHg或更高的患者，医院死亡率升高7.7%（调整后HR，1.077；95%CI，1.018 - 1.139；P = 0.0096）。
结论
对于非创伤性SAH患者，基线PP与医院死亡风险之间的关联是非线性的，拐点为60mmHg，基线PP水平在57至68mmHg（Q2）时风险最低。
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