Significance of blood pressure variability in patients with sepsis

doi:10.5847/wjem.j.issn.1920-8642.2014.01.007

Abstract

Abstract:

BACKGROUND: This study was undertaken to observe the characteristics of blood pressure variability (BPV) and sepsis and to investigate changes in blood pressure and its value on the severity of illness in patients with sepsis.
METHODS: Blood parameters, APACHE II score, and 24-hour ambulatory BP were analyzed in 89 patients with sepsis.
RESULTS: In patients with APACHE II score>19, the values of systolic blood pressure (SBPV), diasystolic blood pressure (DBPV), non-dipper percentage, cortisol (COR), lactate (LAC), platelet count (PLT) and glucose (GLU) were significantly higher than in those with APACHE II score ≤19 (P<0.05 ), whereas the values of procalcitonin (PCT), white blood cell (WBC), creatinine (Cr), PaO₂, C-reactive protein (CRP), adrenocorticotropic hormone (ACTH) and tumor necrosis factor α (TNF-α) were not statistically significant (P>0.05). Correlation analysis showed that APACHE II scores correlated significantly with SBPV and DBPV (P<0.01, r=0.732 and P<0.01, r=0.762). SBPV and DBPV were correlated with COR (P=0.018 and r=0.318; P=0.008 and r=0.353 respectively). However, SBPV and DBPV were not correlated with TNF-α, IL-10, and PCT (P>0.05). Logistic regression analysis of SBPV, DBPV, APACHE II score, and LAC was used to predict prognosis in terms of survival and non-survival rates. Receiver operating characteristics curve (ROC) showed that DBPV was a better predictor of survival rate with an AUC value of 0.890. However, AUC of SBPV, APACHE II score, and LAC was 0.746, 0.831 and 0.915, respectively.
CONCLUSIONS: The values of SBPV, DBPV and non-dipper percentage are higher in patients with sepsis. DBPV and SBPV can be used to predict the survival rate of patients with sepsis.

Key words: Sepsis, Systolic blood pressure variability, Diastolic blood pressure variability, APACHE II score, Inflammatory factor

Nishant Raj Pandey, Yu-yao Bian, Song-tao Shou. Significance of blood pressure variability in patients with sepsis[J]. World Journal of Emergency Medicine, 2014, 5(1): 42-47.

Figures/Tables 4

Table 1

Table 2

Table 3

Figure 1.

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Variables	APACHE II score≤19	APACHE II score>19	μ/t value	P value
SBPV (mmHg)	35.00 (15.50)	58.00 (17.00)	652.50	0.006
DBPV (mmHg)	33.00 (11.50)	57.00 (20.00)	78.50	0.000
24-h SBP (mmHg)	131.00 (22.09)	147.50 (16.00)	216.50	0.011
24-h DBP (mmHg)	72.50 (17.87)	77.50 (11.62)	315.00	0.410
SBP-day (mmHg)	123.80 (16.91)	144.30 (16.90)	44.00	0.013
DBP-day (mmHg)	73.69 (7.95)	77.64 (10.30)	63.00	0.106
SBP-night (mmHg)	127.10 (16.91)	139.90 (16.15)	55.50	0.085
DBP-night (mmHg)	73.61 (10.01)	73.64 (9.19)	79.00	0.560
24-h PP (mmHg)	58.60 (22.57)	68.35 (6.47)	50.00	0.027
PP-day (mmHg)	58.05 (21.85)	68.70 (7.60)	47.00	0.019
PP-night (mmHg)	60.00 (24.32)	66.95 (12.20)	45.50	0.014
Dipper (%)	21.42	7.14
White blood cell (×10⁹/L)	9.57 (08.50)	12.67 (13.74)	715.00	0.138
Platelet count (×10⁹/L)	122.00 (27.00)	134.00 (109.2)	506.00	0.003
Creatinine (μmol/L)	68.00 (23.50)	68.50 (91.87)	795.00	0.813
PaO₂	83.00 (43.50)	73.50 (45.00)	631.50	0.075
C-reactive protein (μg/L)	3.81 (11.32)	7.67 (14.69)	551.50	0.150
Adrenocorticotropic hormone (ng/L)	29.00 (24.40)	31.00 (24.90)	869.00	0.632
TNF-α (ng/L)	25.77 (03.41)	26.28 (4.76)	196.00	0.924
IL-10 (ng/L)	88.39 (23.27)	83.27 (17.76	3.62	0.260
Glucose (mmol/L)	4.70 (1.30)	8.70 (6.35)	292.50	0.000
Mortality (%)	0	29.54

Variables		APACHE II	Cortisol	Adrenocorticotropic hormone	Tumor necrosis factor-α	IL-10	Platelet count	C-reactive protein
SBPV	r_s	0.732^**	0.318^*	0.127	-0.080	0.156	0.026	0.123
	P	0.000	0.018	0.361	0.682	0.420	0.848	0.410
	n	56	55	54	29	29	55	47
DBPV	r_s	0.762^**	0.353^**	0.163	-0.135	0.219	0.189	0.328^*
	P	0.000	0.008	0.240	0.484	0.254	0.167	0.024
	n	56	55	54	29	29	55	47

Variables	B	S.E.	Wald	df	Significance	Exp (B)
SBPV	0.073	0.029	6.219	1	0.013	1.076
DBPV	0.104	0.036	8.227	1	0.004	1.11
APACHE II	0.225	0.059	14.626	1	0.000	1.252
Cortisol	0.138	0.042	10.757	1	0.001	1.148
Lactate	0.286	0.074	14.868	1	0.000	1.331
Glucose	0.161	0.057	7.893	1	0.005	1.175

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