In septic ICU patients, lower level of all BP components linked to higher mortality, myocardial and acute kidney injury

USA: A recent retrospective observational study conducted by intensivists at the eICU Research Institute has shed light on the relationship between individual blood pressure components and organ dysfunction in critically ill septic patients. Researchers have found that in septic ICU patients, lower level of all blood pressure components including mean, systolic, diastolic and pulse pressure were associated with higher mortality, acute kidney injury and myocardial injury.

The study was published in the Annals of Intensive Care.

The purpose of this study was to look at the association between different blood pressure components and organ dysfunction in critically ill septic patients.

The study evaluated a staggering 77,328 septic patients across 364 intensive care units (ICUs). The primary objective of the study was to examine the association between different blood pressure components and ICU mortality, with secondary outcomes focusing on composite outcomes of acute kidney injury or death and myocardial injury or death during ICU stay.

The research team analyzed data from the eICU Research Institute database, conducting multivariable logistic regression spline and threshold regression analyses while adjusting for potential confounders.

The study concluded with the following clinical takeaways:

1. Lower values of blood pressure components are associated with a higher risk of ICU mortality.

2. Change points indicating an increased risk of ICU mortality were identified: 69 mmHg for mean pressure, 100 mmHg for systolic pressure, 60 mmHg for diastolic pressure, and 57 mmHg for pulse pressure.

3. The strength of association between blood pressure components and ICU mortality, as measured by threshold regression slopes, were mean (-0.13), systolic (-0.11), diastolic (-0.09), and pulse pressure (-0.05).

4. Similar non-linear associations were found between blood pressure components and ICU mortality in septic shock patients.

5. The relationship between blood pressure components and secondary outcomes showed a similar pattern.

The study's conclusions emphasize the need for further research and analysis to explore the relationship between blood pressure components and different sepsis phenotypes in critically ill ICU patients. Understanding these associations more comprehensively could provide critical care teams with tailored approaches for managing sepsis and improving patient outcomes.

This ground-breaking research serves as a stepping stone toward enhancing the understanding of sepsis management and optimizing treatment strategies for critically ill patients in the ICU, ultimately striving for improved patient care and outcomes.

Reference:

Khanna, A.K., Kinoshita, T., Natarajan, A. et al. Association of systolic, diastolic, mean, and pulse pressure with morbidity and mortality in septic ICU patients: a nationwide observational study. Ann. Intensive Care 13, 9 (2023). https://doi.org/10.1186/s13613-023-01101-4