血压变异与脓毒症患者住院死亡的关系

doi:10.3969/j.issn.1006-7795.2024.02.002

首都医科大学学报 ›› 2024, Vol. 45 ›› Issue (2): 181-186.doi: 10.3969/j.issn.1006-7795.2024.02.002

• 重症医学诊疗技术与进展 • 上一篇下一篇

血压变异与脓毒症患者住院死亡的关系

苏维雪¹, 姜利¹, 席修明², 王楠¹, 刘宇雁¹, 王婷婷1, 司权1, 朱波², 姜琦² ,王美平^1*

1. 首都医科大学宣武医院重症医学科，北京 100053；2. 首都医科大学附属复兴医院重症医学科，北京 100038

收稿日期:2023-12-10 出版日期:2024-04-21 发布日期:2024-04-25
通讯作者: 王美平 E-mail:xiaomeiccmu@163.com
基金资助:
国家临床重点专科建设项目（2021-451号），北京市重大疫情防治重点专科项目（2021-135号）.

The correlation between systolic blood pressure variability and in-hospital mortality in patients with sepsis

Su Weixue¹, Jiang Li¹, Xi Xiuming², Wang Nan¹, Liu Yuyan¹, Wang Tingting¹, Si Quan¹, Zhu Bo², Jiang Qi², Wang Meiping^1*

1. Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China；2. Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing 100038, China

Received:2023-12-10 Online:2024-04-21 Published:2024-04-25
Supported by:
This study was supported by National Key Clinical Specialty Construction Project (2021-451)，Key Specialized Projects of Major Epidemic Prevention and Control in Beijing (2021-135).

摘要/Abstract

摘要： 目的探讨收缩压变异与脓毒症患者住院病死率的关系。方法本研究为多中心前瞻性队列研究。数据来源于2013年1月至2014年8月完成的“中国危重症患者脓毒症调查”。纳入年龄≥18岁、重症监护病房（intensive care unit, ICU）住院时间≥24 h的脓毒症患者为研究对象。记录患者诊断脓毒症后首个24 h收缩压情况并计算患者收缩压变异系数(systolic blood pressure coefficient of variation，SBP_cv)，按SBP_cv四分位数将患者分为四组（Q₁、Q₂、Q₃、Q₄组）。采用多因素Logistic回归探讨收缩压变异与住院死亡的关系。结果 1 356例脓毒症患者纳入本研究，男性929 (68.5%)例，女性427(31.5%)例，年龄67.0 (52.0, 78.0)岁，483 (35.6%)例患者住院期间死亡。脓毒症患者SBP_cv与住院死亡风险增加有关。校正了潜在的混杂因素后，SBP_cv每增加10%，住院死亡发生风险增加43% (OR=1.43, 95%CI:1.11~1.98)。且与Q1组患者相比，Q4组患者住院死亡发生风险增加69%（OR=1.69, 95%CI: 1.31~2.25），28 d死亡发生风险增加23%(OR=1.23, 95%CI:1.07~1.84)。结论较大的SBP_cv与脓毒症患者住院死亡风险、28 d死亡风险增加有关。

关键词: 脓毒症, 血压变异, 收缩压变异系数, 住院病死率

Abstract: Objective To explore the association between systolic blood pressure variability and in-hospital mortality in patients with sepsis. Methods This study was a prospective, multicenter, and cohort study. Data were derived from the China Critical Care Sepsis Trial, which was conducted from January 2013 to August 2014. Patients aged ≥18 years with length of stay of intensive care unit （ICU）more than 24 h were included. The patients who were diagnosed as sepsis for more than 48 h and lack of blood pressure for 2 h or longer were excluded. Systolic blood pressure, diastolic blood pressure, fluid intake and output were collected. The systolic blood pressure coefficient of variation (SBP_cv) was calculated and divided into four groups (Q₁, Q₂, Q₃, Q₄) according to the interquartile of SBP_cv. The multivariable Logistic regression was applied to explore the association between systolic blood pressure variability and in-hospital mortality. Results A total of 1 356 patients with sepsis were included, with 929 (68.5%) males and 427 (31.5%) females, median age 67.0 years (52.0, 78.0).Among them, 483 (35.6%) patients died during hospitalization. After adjusting for potential confounding factors, for every 10% of SBP_cv increasing, the risk of in-hospital mortality increased 43% (OR=1.43, 95%CI:1.11-1.98). Compared with Q1 group, patients in Q4 group had a 69% increased risk of in-hospital mortality (OR=1.69, 95%CI:1.31-2.25) and a 23% increased risk of 28 d mortality (OR=1.23, 95%CI:1.07-1.84). Conclusion Higher systolic blood pressure variability was correlated with higher risks of in-hospital mortality and 28 d mortality.

Key words: sepsis, blood pressure variability, systolic blood pressure coefficient of variation, in-hospital mortality

中图分类号:

R631

苏维雪, 姜利, 席修明, 王楠, 刘宇雁, 王婷婷, 司权, 朱波, 姜琦, 王美平. 血压变异与脓毒症患者住院死亡的关系[J]. 首都医科大学学报, 2024, 45(2): 181-186.

Su Weixue, Jiang Li, Xi Xiuming, Wang Nan, Liu Yuyan, Wang Tingting, Si Quan, Zhu Bo, Jiang Qi, Wang Meiping. The correlation between systolic blood pressure variability and in-hospital mortality in patients with sepsis[J]. Journal of Capital Medical University, 2024, 45(2): 181-186.

参考文献

［1］ Juhanoja E P, Niiranen T J, Johansson J K, et al. Outcome-driven thresholds for increased home blood pressure variability［J］. Hypertension, 2017, 69(4):599-607.
［2］ Stevens S L, Wood S, Koshiaris C, et al. Blood pressure variability and cardiovascular disease: systematic review and meta-analysis［J］. BMJ, 2016, 354:i4098.
［3］ Heshmatollah A, Ma Y, Fani L, et al. Visit-to-visit blood pressure variability and the risk of stroke in the Netherlands: a population-based cohort study［J］. PLoS Med, 2022, 19(3):e1003942.
［4］ Takahashi O, Glasziou P P, Perera R, et al. Blood pressure re-screening for healthy adults: what is the best measure and interval ［J］. J Hum Hypertens, 2012, 26: 540-546.
［5］ Zorko G N, Valencia M D J, Singh T D, et al. Association of blood pressure variability with delirium in patients with critical illness［J］. Neurocrit Care,2023,39(3):646-654.
［6］ Zhao J, Yuan F, Fu F, et al. Blood pressure variability and outcome in acute severe stroke: a post hoc analysis of CHASE-A randomized controlled trial［J］. J Clin Hypertens, 2021, 23(1):96-102.
［7］ Hsieh Y T, Tu S T, Cho T J, et al. Visit-to-visit variability in blood pressure strongly predicts all-cause mortality in patients with type 2 diabetes: a 5.5-year prospective analysis［J］. Eur J Clin Invest, 2012,42(3):245-253.
［8］ Bae E H, Lim S Y, Han K D, et al. Association between systolic and diastolic blood pressure variability and the risk of end-stage renal disease［J］. Hypertension, 2019,74(4):880-887.
［9］ Xie Z, Liao X, Yin W, et al. Relationship between short-term blood pressure variability and incidence of acute kidney injury in critically ill patients［J］. Kidney Blood Press Res, 2017,42(6):1238-1246.
［10］ Floras J S. Blood pressure variability: a novel and important risk factor［J］. Can J Cardiol, 2013, 29(5):557-563.
［11］ Nouriel J E, Millis S R, Ottolini J, et al. Blood pressure variability as an indicator of sepsis severity in adult emergency department patients［J］. Am J Emerg Med, 2018, 36(4):560-566.
［12］ Zhu Y, Li Y, Cai W, et al. Predictive value of blood pressure variability for organ dysfunction in patients with sepsis［J］. Ann Palliat Med, 2021, 10(9):9678-9684.
［13］ Wang M, Jiang L, Zhu B, et al. The prevalence, risk factors, and outcomes of sepsis in critically ill patients in China: a multicenter prospective cohort study［J］. Front Med (Lausanne) , 2020, 7:593808.
［14］ Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021［J］. Crit Care Med, 2021, 49(11):e1063-e1143.
［15］ Bennett A E, Wilder M J, McNally J S, et al. Increased blood pressure variability after endovascular thrombectomy for acute stroke is associated with worse clinical outcome［J］. J Neurointerv Surg, 2018, 10(9):823-827.
［16］ Tully P J, Yano Y, Launer L J, et al. Association between blood pressure variability and cerebral small-vessel disease: a systematic review and meta-analysis［J］. J Am Heart Assoc, 2020, 9(1):e013841.
［17］ Saito K, Saito Y, Kitahara H, et al. In-hospital blood pressure variability: a novel prognostic marker of renal function decline and cardiovascular events in patients with coronary artery disease［J］. Kidney Blood Press Res, 2020, 45(5):748-757.
［18］ Mena L J, Maestre G E, Hansen T W , et al. How many measurements are needed to estimate blood pressure variability without loss of prognostic information［J］. Am J Hypertens, 2014, 27(1):46-55.
［19］ Tang Y, Sorenson J, Lanspa M, et al. Systolic blood pressure variability in patients with early severe sepsis or septic shock: a prospective cohort study［J］. BMC Anesthesiol, 2017, 17(1):82.
［20］ Hou C, Wang X, Li Y, et al. The relationship between short-term mean arterial pressure variability and mortality in critically ill patients［J］. Front Cardiovasc Med, 2022, 9:870711.
［21］ Jones A E, Trzeciak S, Kline J A. The sequential organ failure assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation［J］. Crit Care Med, 2009 May;37(5):1649-1654.
［22］ Sakr Y, Rubatto B P N, Kotfis K, et al. Higher fluid balance increases the risk of death from sepsis: results from a large international audit［J］. Crit Care Med, 2017,45(3):386-394.
［23］ Leisman D E, Doerfler M E, Schneider S M, et al. Predictors, prevalence, and outcomes of early crystalloid responsiveness among initially hypotensive patients with sepsis and septic shock［J］. Crit Care Med, 2018, 46(2):189-198.
［24］ Kellum J A, Chawla L S, Keener C, et al. The effects of alternative resuscitation strategies on acute kidney injury in patients with septic shock［J］. Am J Respir Crit Care Med, 2016, 193(3):281-287.
［25］ Wang N, Jiang L, Zhu B, et al. Fluid balance and mortality in critically ill patients with acute kidney injury: a multicenter prospective epidemiological study［J］. Crit Care, 2015, 19:371.

[1]	李俊聪, 赵松, 于凯, 韩玉珍, 郭方兴, 李文雄. 迷走神经刺激改善大鼠脓毒症诱发的肾功能损伤[J]. 首都医科大学学报, 2024, 45(2): 201-206.
[2]	宋倩, 周倩, 孙宏, 李硕, 梅雪, 郭瑞君, 葛辉玉. Lindegaard指数预测早期脓毒症相关性脑病的临床价值[J]. 首都医科大学学报, 2023, 44(6): 959-965.

血压变异与脓毒症患者住院死亡的关系

The correlation between systolic blood pressure variability and in-hospital mortality in patients with sepsis

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 2

编辑推荐

Metrics

本文评价