Systolic blood pressure variability in patients with early severe sepsis or septic shock: a prospective cohort study

BMC Anesthesiology

Research Article

Yi Tang¹  V.J. Mathews¹  Jeff Sorenson²  Michael Lanspa³  Colin K. Grissom³  Samuel M. Brown⁴ 

[1] Electrical and Computer Engineering, University of Utah, 50 Central Campus Dr #2110, 84112, Salt Lake City, UT, USA;Pulmonary and Critical Care, Intermountain Medical Center, 5121 Cottonwood St, 84107, Murray, UT, USA;Pulmonary and Critical Care, Intermountain Medical Center, 5121 Cottonwood St, 84107, Murray, UT, USA;Pulmonary and Critical Care, University of Utah School of Medicine, 30 N 1900 E, 84132, Salt Lake City, UT, USA;Pulmonary and Critical Care, Intermountain Medical Center, 5121 Cottonwood St, 84107, Murray, UT, USA;Pulmonary and Critical Care, University of Utah School of Medicine, 30 N 1900 E, 84132, Salt Lake City, UT, USA;Shock Trauma Intensive Care Unit, 5121 South Cottonwood Street, 84107, Murray, UT, USA;

关键词: Sepsis;    Shock;    Physiological variability;    Arterial blood pressure;   

DOI  :  10.1186/s12871-017-0377-4

 received in 2017-02-22, accepted in 2017-06-08,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundSevere sepsis and septic shock are often lethal syndromes, in which the autonomic nervous system may fail to maintain adequate blood pressure. Heart rate variability has been associated with outcomes in sepsis. Whether systolic blood pressure (SBP) variability is associated with clinical outcomes in septic patients is unknown. The propose of this study is to determine whether variability in SBP correlates with vasopressor independence and mortality among septic patients.MethodsWe prospectively studied patients with severe sepsis or septic shock, admitted to an intensive care unit (ICU) with an arterial catheter. We analyzed SBP variability on the first 5-min window immediately following ICU admission. We performed principal component analysis of multidimensional complexity, and used the first principal component (PC1) as input for Firth logistic regression, controlling for mean systolic pressure (SBP) in the primary analyses, and Acute Physiology and Chronic Health Evaluation (APACHE) II score or NEE dose in the ancillary analyses. Prespecified outcomes were vasopressor independence at 24 h (primary), and 28-day mortality (secondary).ResultsWe studied 51 patients, 51% of whom achieved vasopressor independence at 24 h. Ten percent died at 28 days. PC1 represented 26% of the variance in complexity measures. PC1 was not associated with vasopressor independence on Firth logistic regression (OR 1.04; 95% CI: 0.93–1.16; p = 0.54), but was associated with 28-day mortality (OR 1.16, 95% CI: 1.01–1.35, p = 0.040).ConclusionsEarly SBP variability appears to be associated with 28-day mortality in patients with severe sepsis and septic shock.

【 授权许可】

CC BY   
© The Author(s). 2017