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Impact of Mean Arterial Pressure Fluctuation on Mortality in Critically Ill Patients

Gao, Ya, MD1; Wang, Qinfen, MSc2; Li, Jiamei, MD1; Zhang, Jingjing, MD1; Li, Ruohan, MD1; Sun, Lu, MD3; Guo, Qi, MD4; Xia, Yong, PhD2; Fang, Bangjiang, MD, PhD5; Wang, Gang, MD, PhD1

doi: 10.1097/CCM.0000000000003435
Online Clinical Investigations

Objective: The purpose of this study was to investigate the association between mean arterial pressure fluctuations and mortality in critically ill patients admitted to the ICU.

Design: Retrospective cohort.

Setting: All adult ICUs at a tertiary care hospital.

Patients: All adult patients with complete mean arterial pressure records were selected for analysis in the Multiparameter Intelligent Monitoring in Intensive Care II database. Patients in the external cohort were newly recruited adult patients in the Medical Information Mart for Intensive Care III database.

Interventions: None.

Measurements and Main Results: The records of 8,242 patients were extracted. Mean arterial pressure fluctuation was calculated as follows: (mean nighttime mean arterial pressure – mean daytime mean arterial pressure)/mean arterial pressure. Patients were divided into two groups according to the degree of mean arterial pressure fluctuation: group A (between –5% and 5%) and group B (<–5% and >5%). The endpoints of this study were ICU and hospital mortality. Patients in group A (n = 4,793) had higher ICU and hospital mortality than those in group B (n = 3,449; 11.1% vs 8.1%, p < 0.001 and 13.8% vs 10.1%, p < 0.001, respectively). After adjusting for other covariates, the mean arterial pressure fluctuations between –5% and 5% were significantly correlated with ICU mortality (odds ratio, 1.296; 95% CI, 1.103–1.521; p = 0.002) and hospital mortality (odds ratio, 1.323; 95% CI, 1.142–1.531; p < 0.001). This relationship remained remarkable in patients with low or high Sequential Organ Failure Assessment scores in the sensitive analysis. Furthermore, external validation on a total of 4,502 individuals revealed that patients in group A still had significantly higher ICU (p < 0.001) and hospital mortality (p < 0.001) than those in group B.

Conclusions: The reduced mean arterial pressure fluctuation (within –5% and 5%) may be associated with ICU and hospital mortality in critically ill patients.

1Department of Critical Care Medicine, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi'an, China.

2National Engineering Laboratory for Integrated Aero-Space-Ground-Ocean Big Data Application Technology, School of Computer Science and Engineering, Northwestern Polytechnical University, Xi'an, China.

3Department of Ultrasound, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi'an, China.

4Department of Cardiology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi'an, China.

5Department of Emergency Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.

The sponsors of this research played no role in the research process of this study beyond their important financial contribution.

Dr. Gao and Ms. Q. Wang contributed equally to this work.

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The Multiparameter Intelligent Monitoring in Intensive Care II database was supported by the National Institute of Biomedical Imaging and Bioengineering of the National Institutes of Health (grant number: R01 EB001659).

Dr. G. Wang received the Scientific Fund for the Young Talent of Shaanxi Province (2015KJXX-06). He received support for article research from the government of Shaanxi Province, China. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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