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

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。

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.

关键词

脓毒症 / 血压变异 / 收缩压变异系数 / 住院病死率

Key words

sepsis / blood pressure variability / systolic blood pressure coefficient of variation / in-hospital mortality