Emergency department hypotension predicts sudden unexpected in-hospital mortality - A prospective cohort study
Emergency department hypotension predicts sudden unexpected in-hospital mortality - A prospective cohort study
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DOI：
10.1378/chest.130.4.941
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发表时间：
2006-10-01
期刊：
影响因子：
9.6
通讯作者：
Kline, Jeffrey A.
中科院分区：
文献类型：
--
作者：
Jones, Alan E.;Yiannibas, Vasilios;Kline, Jeffrey A.
目的：急诊科（艾德）测量的非创伤性低血压的患病率和预后意义尚未研究。我们假设，艾德低血压赋予的风险，在hospitalmortal.Design：前瞻性队列研究。设置：大型城市艾德与115，000年的访问。参与者：年龄> 17岁的非tramna艾德患者入院前瞻性地确定在2004年至2005年的24小时块随机样本。“暴露组”在艾德的收缩压（SBP）< 100 mmHg;“非暴露组”在ED的收缩压均为2：100 mmHg。独立观察者使用明确的标准将死亡分类为突发和意外。结果测量：死亡率与置信区间（CI）、Kaplan-Meier生存曲线和多变量logistic回归进行比较。研究期间共入组了4，790例患者，其中暴露组有887例患者（19%）。与未暴露者相比，暴露者更有可能在医院死亡（8% vs 3%; 95%CI差异为5%，4 - 8%）。与未暴露者相比，暴露者更可能发生猝死和意外死亡（2% vs 0.2%，95% CI差异为1.8%，1 - 3%）。Kaplan-Meier估计值显示暴露组在所有时间点的死亡率增加（对数秩检验，p < 0.001）。多变量逻辑回归显示，低血压是住院死亡率的独立预测因素（比值比，2.0; 95%CI，1.3至2.8）。结论：在入院的艾德患者随机样本中，19%的患者记录到非创伤性低血压。暴露于低血压的患者在住院期间的死亡风险显著增加。
Objective: The prevalence and prognostic significance of nontramnatic hypotension measured in the emergency department (ED) have not been studied. We hypothesized that ED hypotension confers risk of in-hospital mortality.Design: Prospective cohort study.Setting: Large urban ED with 115,000 visits per year.Participants: Nontramna ED patients aged > 17 years admitted to the hospital were prospectively identified on a random sample of 24-h blocks during 2004 to 2005. "Exposures" had any systolic BP (SBP) < 100 nun Hg in the ED; "nonexposures" all had SBP 2: 100 mm Hg in the ED. Deaths were classified as sudden and unexpected by independent observers using explicit criteria.Outcome measures: Mortality rates were compared with confidence intervals (CIs), Kaplan-Meier survival curves, and multivariate logistic regression.Results: A total of 4,790 patients were enrolled during the study period, with 887 patients (19%) in the exposure group. Exposures were more likely to die in the hospital compared with nonexposures (8% vs 3%; 95% CI for difference of 5%, 4 to 8%). Exposures were more likely to have sudden and unexpected death compared with nonexposures (2% vs 0.2%, 95% CI for difference of 1.8%, 1 to 3%). Kaplan-Meier estimates showed increased mortality in the exposure group at all time points (log-rank test, p < 0.001). Multivariate logistic regression revealed exposure to hypotension as an independent predictor of in-hospital mortality (odds ratio, 2.0; 95% CI, 1.3 to 2.8).Conclusion: Nontraumatic hypotension was documented in 19% of a random sample of ED patients admitted to the hospital. Patients exposed to hypotension had a significantly increased risk of death during hospitalization.