Characteristics and Factors Associated With the Mortality of Hypotensive Patients Attending the Emergency Department

BACKGROUND: The prevalence of hypotension in emergency departments (EDs) is approximately 1-2%, but is associated with a mortality rate of 8-15%. There has never been a study in Thailand examining the epidemiology or the risk factors for early mortality of patients presenting with hypotension in the ED. Therefore, this study aimed to define the characteristics, mortality rate within 48 h and associated factors of hypotensive patients at ED. METHODS: Data of patients with hypotension attending the ED of Thammasat University Hospital (TUH) were retrospectively studied. RESULTS: Of the 9,000 patients seen in the TUH ED, 233 were hypotensive for a prevalence of 2.5%. Patients were old, with a mean age of 61 ± 20 years. The most common presenting symptom was fever, and sepsis was the most common cause of hypotension. The mean systolic blood pressure (SBP) was 78 ± 8 mm Hg. Isotonic crystalloid volume resuscitation in first hour was 758 mL (interquartile range (IQR), 500 - 1,000) and the total volume to achieve a mean arterial pressure (MAP) ≥ 65 mm Hg was 1,142 mL (IQR, 500 - 1,500). Twenty-seven percent of patients needed vasopressor support. Nineteen patients died ≤ 48 h, giving a case fatality rate of 8.2%. Three independent factors associated with 48-h mortality were initial pulse rate > 100 beats/min (odds ratio (OR), 4.21; 95% confidence interval (CI), 1.05 - 16.88; P = 0.042), diagnosis of shock (OR, 13.74 (1.49 - 126.61); P = 0.021) and recurrent hypotension (OR, 6.91 (1.54 - 30.99); P = 0.012). CONCLUSIONS: Hypotension in the ED was common and associated with high mortality rate. Better triage, patient monitoring and treatment may improve outcomes in these patients.