Arterial blood pressure correlates with 90-day mortality in sepsis patients: a retrospective multicenter derivation and validation study using high-frequency continuous data
Arterial blood pressure correlates with 90-day mortality in sepsis patients: a retrospective multicenter derivation and validation study using high-frequency continuous data
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DOI：
10.1097/mbp.0000000000000398
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发表时间：
2019-10-01
影响因子：
1.3
通讯作者：
Yamauchi, Masanori
中科院分区：
文献类型：
--
作者：
Kobayashi, Naoya;Nakagawa, Atsuhiro;Yamauchi, Masanori
目的探讨高频血压监测对脓毒症患者预后的影响。材料与方法本回顾性观察性研究在一所大学医院ICU（衍生研究）和两所城市医院（验证研究）进行，数据来自同期访问中心的成人脓毒症患者。计算血压降至阈值以下的曲线下面积（AUC）。预测的90天死亡率（主要终点）阈值下面积（AUT）和临界血压分别计算为受试者工作特征曲线（AUCROC）的最大曲线下面积和阈值减去平均AUT（推导研究）。对于验证研究，将推导的90天死亡率AUCROC（使用临界血压）与序贯器官衰竭评估（SOFA）、简化急性生理学评分（SAPS）II、急性生理学和慢性健康评估（APACHE）II和APACHE III进行比较。结果推导队列（N = 137）：24-48 h平均血压70 mmHg的下降面积最准确地预测90 d死亡率[临界血压，67.8 mmHg; AUCROC，0.763; 95%可信区间（CI），0.653-0.890]。验证队列（N = 141）：90天死亡率AUCROC（0.776）与SOFA（0.711）、SAPSII（0.771）、APACHE II（0.745）和APACHE III（0.710）的AUCROC相比，与临界血压67.8 mmHg无显著差异（P = 0.420）。结论高频动脉血压监测可反映脓毒症患者血压下降的时间和程度，对脓毒症患者的临床预后有一定的预测价值。
Objective To identify the outcome of patients with sepsis using high-frequency blood pressure data. Materials and methods This retrospective observational study was conducted at a university hospital ICU (derivation study) and at two urban hospitals (validation study) with data from adult sepsis patients who visited the centers during the same period. The area under the curve (AUC) of blood pressure falling below threshold was calculated. The predictive 90-day mortality (primary endpoint) area under threshold (AUT) and critical blood pressure were calculated as the maximum area under the curve of the receiver operating characteristic curve (AUCROC) and the threshold minus average AUT (derivation study), respectively. For the validation study, the derived 90-day mortality AUCROC (using critical blood pressure) was compared with Sequential Organ Failure Assessment (SOFA), Simplified Acute Physiology Score (SAPS) II, Acute Physiology and Chronic Health Evaluation (APACHE) II, and APACHE III. Results Derivation cohort (N = 137): the drop area from the mean blood pressure of 70 mmHg at 24-48 hours most accurately predicted 90-day mortality [critical blood pressure, 67.8 mmHg; AUCROC, 0.763; 95% confidence interval (CI), 0.653-0.890]. Validation cohort (N = 141): the 90-day mortality AUCROC (0.776) compared with the AUCROC for SOFA (0.711), SAPSII (0.771), APACHE II (0.745), and APACHE III (0.710) was not significantly different from the critical blood pressure 67.8 mmHg (P = 0.420). Conclusion High-frequency arterial blood pressure data of the period and extent of blood pressure depression can be useful in predicting the clinical outcomes of patients with sepsis.