成年ICU患者反勺型血压变异对医院病死率的影响

The association between reverse-dipper blood pressure pattern and hospital mortality in adult critically ill patients

目的探讨成年重症监护室(ICU)患者非勺型及反勺型血压变异对医院病死率的影响。方法采用回顾性队列研究,纳入单次收住ICU且ICU住院时长>24h的勺型、非勺型及反勺型血压变异成年患者。并提取患者的年龄、性别、种族、首次序贯器官衰竭评分(SOFA评分)、首次简化急性生理评分(SAPS-Ⅰ评分)、服用血管活性药物、镇静药情况以及患病情况等。将患者是否于医院死亡及血压变异类型分别作为因变量和自变量纳入Logistic回归模型,并在不同SOFA评分患者中进行亚组分析。结果本研究共纳入患者8306例,其中勺型血压变异患者1285例(15.5%),非勺型血压变异患者3608例(43.4%),反勺型血压变异患者3413例(41.1%),医院病死率在三组分别为13.0%、12.1%及15.8%。反勺型血压变异患者的医院病死率是勺型血压患者的1.258倍(95%CI1.015~1.558)。在4874例SOFA评分≤8的患者中,反勺型血压变异患者的医院病死率是勺型血压变异患者的1.691倍(95%CI1.218~2.347)。结论反勺型血压变异可能是ICU患者医院死亡的危险因素之一,在病情相对较轻的患者中危险度更高。

Objective To explore the association between non-dipper and reverse-dipper blood pressure(BP)variations and hospital mortality in adult critically ill patients.Methods Adult patients with over 24 hours of intensive care unit(ICU)stay and either dipper,non-dipper or reverse-dipper BP pattern in the Multiparameter Intelligent Monitoring in Intensive Care Ⅱ database were included in this retrospective cohort study.The patients'information on age,gender,ethnicity,first SOFA score,first SAPS-Ⅰ score,medication usage on day 1 of admission to the ICU,and comorbidities were extracted.Data for continuous and categorical variables were presented as median with interquartile range(IQR)and frequencies with percentages,respectively.The hospital mortality and the pattern of BP variation were used as the dependent variables and independent variables respectively in multivariate Logistic regression and confounding factors were controlled.Results A total of 8306 critically ill patients were enrolled in the analysis.Among them,1285(15.5%)were dippers,3608(43.4%)were non-dippers,and 3413(41.1%)were reverse-dippers.The hospital mortality was 13.0%,12.1% and 15.8% respectively.After controlling for confounding factors,Logistic regression revealed significant association between reverse-dipper BP pattern and hospital mortality(OR=1.258,95% CI 1.015-1.558).Subgroup analysis of those 4874 patients with SOFA score showed that the results were similar as in the whole population(reverse dippers:OR=1.691,95% CI 1.218 ~2.347).There was no significant difference in hospital mortality among different BP variation types in patients with SOFA score>8.Conclusion Reverse-dipper BP variation may be a risk factor for hosptal mortality in adult ICU patients.