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Association between mean arterial pressure during the first 24 hours and hospital mortality in patients with cardiogenic shock

BACKGROUND: The optimal MAP target for patients with cardiogenic shock (CS) remains unknown. We sought to determine the relationship between mean arterial pressure (MAP) and mortality in the cardiac intensive care unit (CICU) patients with CS. METHODS: Using a single-center database of CICU patients...

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Autores principales: Burstein, Barry, Tabi, Meir, Barsness, Gregory W., Bell, Malcolm R., Kashani, Kianoush, Jentzer, Jacob C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7439249/
https://www.ncbi.nlm.nih.gov/pubmed/32819421
http://dx.doi.org/10.1186/s13054-020-03217-6
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author Burstein, Barry
Tabi, Meir
Barsness, Gregory W.
Bell, Malcolm R.
Kashani, Kianoush
Jentzer, Jacob C.
author_facet Burstein, Barry
Tabi, Meir
Barsness, Gregory W.
Bell, Malcolm R.
Kashani, Kianoush
Jentzer, Jacob C.
author_sort Burstein, Barry
collection PubMed
description BACKGROUND: The optimal MAP target for patients with cardiogenic shock (CS) remains unknown. We sought to determine the relationship between mean arterial pressure (MAP) and mortality in the cardiac intensive care unit (CICU) patients with CS. METHODS: Using a single-center database of CICU patients admitted between 2007 and 2015, we identified patients with an admission diagnosis of CS. MAP was measured every 15 min, and the mean of all MAP values during the first 24 h (mMAP(24)) was recorded. Multivariable logistic regression determined the relationship between mMAP(24) and adjusted hospital mortality. RESULTS: We included 1002 patients with a mean age of 68 ± 13.7 years, including 36% females. Admission diagnoses included acute coronary syndrome in 60%, heart failure in 74%, and cardiac arrest in 38%. Vasoactive drugs were used in 72%. The mMAP(24) was higher (75 vs. 71 mmHg, p < 0.001) among hospital survivors (66%) compared with non-survivors (34%). Hospital mortality was inversely associated with mMAP(24) (adjusted OR 0.9 per 5 mmHg higher mMAP(24), p = 0.01), with a stepwise increase in hospital mortality at lower mMAP(24). Patients with mMAP(24) < 65 mmHg were at higher risk of hospital mortality (57% vs. 28%, adjusted OR 2.0, 95% CI 1.4–3.0, p < 0.001); no differences were observed between patients with mMAP(24) 65–74 vs. ≥ 75 mmHg (p > 0.1). CONCLUSION: In patients with CS, we observed an inverse relationship between mMAP(24) and hospital mortality. The poor outcomes in patients with mMAP(24) < 65 mmHg provide indirect evidence supporting a MAP goal of 65 mmHg for patients with CS.
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spelling pubmed-74392492020-08-20 Association between mean arterial pressure during the first 24 hours and hospital mortality in patients with cardiogenic shock Burstein, Barry Tabi, Meir Barsness, Gregory W. Bell, Malcolm R. Kashani, Kianoush Jentzer, Jacob C. Crit Care Research BACKGROUND: The optimal MAP target for patients with cardiogenic shock (CS) remains unknown. We sought to determine the relationship between mean arterial pressure (MAP) and mortality in the cardiac intensive care unit (CICU) patients with CS. METHODS: Using a single-center database of CICU patients admitted between 2007 and 2015, we identified patients with an admission diagnosis of CS. MAP was measured every 15 min, and the mean of all MAP values during the first 24 h (mMAP(24)) was recorded. Multivariable logistic regression determined the relationship between mMAP(24) and adjusted hospital mortality. RESULTS: We included 1002 patients with a mean age of 68 ± 13.7 years, including 36% females. Admission diagnoses included acute coronary syndrome in 60%, heart failure in 74%, and cardiac arrest in 38%. Vasoactive drugs were used in 72%. The mMAP(24) was higher (75 vs. 71 mmHg, p < 0.001) among hospital survivors (66%) compared with non-survivors (34%). Hospital mortality was inversely associated with mMAP(24) (adjusted OR 0.9 per 5 mmHg higher mMAP(24), p = 0.01), with a stepwise increase in hospital mortality at lower mMAP(24). Patients with mMAP(24) < 65 mmHg were at higher risk of hospital mortality (57% vs. 28%, adjusted OR 2.0, 95% CI 1.4–3.0, p < 0.001); no differences were observed between patients with mMAP(24) 65–74 vs. ≥ 75 mmHg (p > 0.1). CONCLUSION: In patients with CS, we observed an inverse relationship between mMAP(24) and hospital mortality. The poor outcomes in patients with mMAP(24) < 65 mmHg provide indirect evidence supporting a MAP goal of 65 mmHg for patients with CS. BioMed Central 2020-08-20 /pmc/articles/PMC7439249/ /pubmed/32819421 http://dx.doi.org/10.1186/s13054-020-03217-6 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Burstein, Barry
Tabi, Meir
Barsness, Gregory W.
Bell, Malcolm R.
Kashani, Kianoush
Jentzer, Jacob C.
Association between mean arterial pressure during the first 24 hours and hospital mortality in patients with cardiogenic shock
title Association between mean arterial pressure during the first 24 hours and hospital mortality in patients with cardiogenic shock
title_full Association between mean arterial pressure during the first 24 hours and hospital mortality in patients with cardiogenic shock
title_fullStr Association between mean arterial pressure during the first 24 hours and hospital mortality in patients with cardiogenic shock
title_full_unstemmed Association between mean arterial pressure during the first 24 hours and hospital mortality in patients with cardiogenic shock
title_short Association between mean arterial pressure during the first 24 hours and hospital mortality in patients with cardiogenic shock
title_sort association between mean arterial pressure during the first 24 hours and hospital mortality in patients with cardiogenic shock
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7439249/
https://www.ncbi.nlm.nih.gov/pubmed/32819421
http://dx.doi.org/10.1186/s13054-020-03217-6
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