基于线性拟合法对危重症患者血压与谵妄关系的研究

Relationship between Blood Pressure and Delirium in Critically Ill Patients

目的低血压增加谵妄的发生率,血压和谵妄存在J曲线效应。本研究探讨重症患者血压(收缩压、平均动脉压、舒张压)与谵妄之间的关系。方法应用真实世界数据集(MIMIC-III数据库、MIMIC-IV数据库和eICU协作研究数据库),使用Cox比例风险回归模型比较高血压与无高血压对重症患者谵妄事件发生率的影响。使用线性拟合绘制不同收缩压、平均动脉压、舒张压对应的谵妄风险比曲线。结果研究纳入78364名患者,APACHE-III评分中位数为39(IQR 28~53)。与非高血压患者相比,高血压患者谵妄发生率更高(OR,1.40;95%CI,1.35~1.46,P<0.001)。不论是否存在高血压,患者血压与谵妄发生风险存U曲线关系,在正常血压范围内谵妄的风险较低。结论高血压是重症患者发生谵妄的独立风险因子。低血压或高血压与谵妄发生风险相关。

Objective Low blood pressure is associated with an increased risk of delirium resulting in the J-curve phenomenon.We assessed the association between blood pressure(systolic blood pressure, mean arterial pressure, diastolic blood pressure)and delirium in critically ill patients.Methods The association between the blood pressure and delirium was investigated using realworld database including MIMIC-Ⅲ database, the MIMIC-Ⅳ database and the eICU Collaborative Research Database.A Cox proportional hazards regression model was used to compare the effect of hypertension versus no hypertension on delirium incidence.The hazard ratio was plotted for delirium with different systolic blood pressure, mean arterial pressure, diastolic blood pressure using natural cubic splines methods.Results 78364 patients were included with median APACHE-Ⅲ score of 39(IQR 28~53).Hypertensive patients had a higher risk of delirium compared with no-hypertension patients(OR,1.40;95% CI,1.35~1.46,P<0.001).Furthermore, an identical shape of the U curve was present with a lower risk of delirium in normal range of blood pressure in patients compared with hypertension or without hypertension.Conclusion Hypertension was an independent predictor of delirium in critically ill patients.Low or high blood pressure were associated with elevated risk of delirium.