Zhao Xiao, Li Hao, Liu Feng, Ren Yuanyuan, Gao Feng
Department of Cardiovascular Surgical Care Unit, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an City, Shaanxi Province, PR China.
Rehabilitation and Treatment Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an City, Shaanxi Province, PR China.
J Clin Hypertens (Greenwich). 2025 Aug;27(8):e70116. doi: 10.1111/jch.70116.
Blood pressure (BP) is a crucial component of the APACHE II scoring system for assessing the severity of illness in ICU patients, and it plays a pivotal role in predicting patient mortality. Based on fluctuations, the 24-h BP patterns of ICU patients can be categorized into dippers (10% ≤ the fall < 20%), extreme-dippers (fall ≥ 20%), non-dippers (0% ≤ the fall < 10%), and reverse-dippers (fall < 0%). This study aims to investigate whether there are statistically significant differences in ICU mortality, in-hospital mortality, 28-day mortality, and 1-year mortality among the dipper, non-dipper, extreme-dipper, and reverse-dipper groups. We enrolled all adult patients with continuous BP monitoring within 24 h of ICU admission. Using Navicat Premium 16 software, we extracted the first 24-h BP values of 10462 patients from the MIMIC IV v2.2 database. Patients were then classified into the dipper group (n = 1244), non-dipper group (n = 6162), reverse-dipper group (n = 2940), and extreme-dipper group (n = 116). Among ICU patients, the non-dipper pattern group constituted the largest proportion (58.90%), followed by the reverse-dipper pattern group (28.10%). After adjusting for relevant confounding factors, we found that the reverse-dipper group had the strongest correlation with in-hospital mortality (OR: 1.592, p < 0.05), 28-day mortality (OR: 1.607, p < 0.01), 90-day mortality (OR: 1.402, p < 0.01), 180-day mortality (OR: 1.403, p < 0.01), and 1-year mortality (OR: 1.525, p < 0.001), with statistical significance observed for all these associations. In the ICU setting, the non-dipper BP pattern is the most prevalent. However, the reverse-dipper pattern is the most significantly associated with mortality.
血压（BP）是评估重症监护病房（ICU）患者病情严重程度的急性生理与慢性健康状况评分系统（APACHE II）的关键组成部分，在预测患者死亡率方面起着关键作用。根据波动情况，ICU患者的24小时血压模式可分为勺型（下降幅度10%≤下降幅度＜20%）、极端勺型（下降幅度≥20%）、非勺型（下降幅度0%≤下降幅度＜10%）和反勺型（下降幅度＜0%）。本研究旨在调查勺型、非勺型、极端勺型和反勺型组在ICU死亡率、住院死亡率、28天死亡率和1年死亡率方面是否存在统计学上的显著差异。我们纳入了所有在ICU入院后24小时内进行持续血压监测的成年患者。使用Navicat Premium 16软件，我们从MIMIC IV v2.2数据库中提取了10462例患者的首个24小时血压值。然后将患者分为勺型组（n = 1244）、非勺型组（n = 6162）、反勺型组（n = 2940）和极端勺型组（n = 116）。在ICU患者中，非勺型模式组占比最大（58.90%），其次是反勺型模式组（28.10%）。在调整了相关混杂因素后，我们发现反勺型组与住院死亡率（比值比：1.592，p＜0.05）、28天死亡率（比值比：1.607，p＜0.01）、90天死亡率（比值比：1.402，p＜0.01）、180天死亡率（比值比：1.403，p＜0.01）和1年死亡率（比值比：1.525，p＜0.001）的相关性最强，所有这些关联均具有统计学意义。在ICU环境中，非勺型血压模式最为普遍。然而，反勺型模式与死亡率的相关性最为显著。
