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.

References 25

1	O'Brien E. Ambulatory blood pressure measurement: a trove of hidden gems? Hypertension 2006; 48:364-365. pmid: 16880346
2	Mancia G, Parati G, Hennig M, Flatau B, Omboni S, Glavina F, et al. Relation between blood pressure variability and carotid artery damage in hypertension: baseline data from the European Lacidipine Study on Atherosclerosis (ELSA). J Hypertens 2001; 19:1981-1989. pmid: 11677363
3	Li WY, Wang XH, Lu LC, Li H. Discrepancy of blood pressure between the brachial artery and radial artery. World J Emerg Med 2013; 4:294-297. doi: 10.5847/wjem.j.issn.1920-8642.2013.04.010 pmid: 25215136
4	Parati G, Pomidossi G, Albini F, Malaspina D, Mancia G. Relationship of 24-hour blood pressure mean and variability to severity of target-organ damage in hypertension. J Hypertens 1987; 5:93-98.
5	Tatasciore A, Renda G, Zimarino M, Soccio M, Bilo G, Parati G, et al. Awake systolic blood pressure variability correlates with target-organ damage in hypertensive subjects. Hypertension 2007; 50:325-332. Epub 2007 Jun 11.
6	Annane D, Sébille V, Charpentier C, Bollaert PE, François B, Korach JM, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 2002; 288:862-871. doi: 10.1001/jama.288.7.862 pmid: 12186604
7	Ren HS, Gao SX, Wang CT, Chu YF, Jiang JJ, Zhang JC, et al. Effects of high-volume hemofiltration on alveolararterial oxygen exchange in patients with refractory septic shock. World J Emerg Med 2011; 2:127-131. pmid: 25214997
8	Cooper MS, Stewart PM. Corticosteroid insufficiency in acutely ill patients. N Engl J Med 2003; 348:727-734. doi: 10.1056/NEJMra020529 pmid: 12594318
9	Briegel J. Hydrocortisone and the reduction of vasopressors in septic shock: therapy or only chart cosmetics? Intensive Care Med 2000; 26:1723-1726. pmid: 11271077
10	No authors listed. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992; 20:864-874. pmid: 1597042
11	Xie J, Lu YM, Shi JD, Deng XQ, Long W. Visfatin levels in patients with severe pneumonia. World J Emerg Med 2011; 2:132-136. doi: 10.5847/wjem.j.1920-8642.2011.02.010 pmid: 25214998
12	Papachristou GI, Muddana V, Yadav D, O'Connell M, Sanders MK, Slivka A, et al. Comparison of BISAP, Ranson's, APACHE-II, and CTSI scores in predicting organ failure,complications, and mortality in acute pancreatitis. Am J Gastroenterol 2010; 105:435-441. doi: 10.1038/ajg.2009.622 pmid: 19861954
13	Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2007; 28:1462-1536. Epub 2007 Jun 11. doi: 10.1093/eurheartj/ehm236 pmid: 17562668
14	Frattola A, Parati G, Cuspidi C, Albini F, Mancia G. Prognostic value of 24-hour blood pressure variability. J Hypertens 1993; 11:1133-1137. doi: 10.1097/00004872-199310000-00019 pmid: 8258679
15	Pierdomenico SD, Di NM, Esposito AL, Di MR, Ballone E, Lapenna D, et al. Prognostic value of different indices of blood pressure variability in hypertensive patients. Am J Hypertens 2009; 22:842-847.
16	Parati G, Bilo G, Vettorello M, Groppelli A, Maronati A, Tortorici E, et al. Assessment of overall blood pressure variability and its different components. Blood Press Monit 2003; 8:155-159.
17	Steinman L. Elaborate interactions between the immune and nervous systems. Nat Immunol 2004; 5:575-581. doi: 10.1038/ni1078 pmid: 15164017
18	Wang HX, Chen B. Diagnostic role of soluble triggering receptor expressed on myeloid cell-1 in patients with sepsis. World J Emerg Med 2011; 2:190-194. pmid: 25215008
19	Waage A, Halstensen A, Espevik T. Association between tumour necrosis factor in serum and fatal outcome in patients with meningococcal disease. Lancet 1987; 1:355-357. pmid: 14246709
20	Oberholzer A, Souza SM, Tschoeke SK, Oberholzer C, Abouhamze A, Pribble JP, et al. Plasma cytokine measurements augment prognostic scores as indicators of outcome in patients with severe sepsis. Shock 2005; 23:488-493.
21	Hotchkiss RS, Coopersmith CM, McDunn JE, Ferguson TA, The sepsis seesaw: tilting toward immunosuppression. Nat Med 2009; 15:496-497. doi: 10.1038/nm0509-496 pmid: 19424209
22	Hotchkiss RS, Karl IE. The pathophysiology and treatment of sepsis. N Engl J Med 2003; 348:138-150. doi: 10.1056/NEJMra021333 pmid: 12519925
23	Joyner MJ, Charkoudian N, Wallin BG. A sympathetic view of the sympathetic nervous system and human blood pressure regulation. Exp Physiol 2008; 93:715-724. pmid: 18326553
24	Charkoudian N, Rabbitts JA. Sympathetic neural mechanisms in human cardiovascular health and disease. Mayo Clin Proc 2009; 84:822-830. doi: 10.1016/S0025-6196(11)60492-8 pmid: 19720780
25	Cowley AW Jr, Liard JF, Guyton AC. Role of the baroreceptor reflex in daily control of arterial blood pressure and other variables in dogs. Circ Res 1973; 32:564-576. pmid: 4713198

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

[1]	Quan Li, Yun Qu, Jinfang Xue, Hai Kang, Chuanzhu Lyu. Exploring lipid-modifying therapies for sepsis through the modulation of circulating inflammatory cytokines: a Mendelian randomization study [J]. World Journal of Emergency Medicine, 2025, 16(3): 256-261.
[2]	Peili Chen, Yan Ge, Huiqiu Sheng, Wenwu Sun, Jiahui Wang, Li Ma, Enqiang Mao. The role of early changes in routine coagulation tests in predicting the occurrence and prognosis of sepsis [J]. World Journal of Emergency Medicine, 2025, 16(2): 136-143.
[3]	Chunxue Wang, Dianyin Yang, Yuxin Zhu, Qian Yang, Tong Liu, Xiandong Liu, Dongyang Zhao, Xiaowei Bao, Tiancao Dong, Li Shao, Lunxian Tang. Circulating circular RNAs act as potential novel biomarkers for sepsis secondary to pneumonia: a prospective cohort study [J]. World Journal of Emergency Medicine, 2025, 16(2): 144-152.
[4]	Azzah S Alharbi, Raghad Hassan Sanyi, Esam I Azhar. Bacteria and host: what does this mean for sepsis bottleneck? [J]. World Journal of Emergency Medicine, 2025, 16(1): 10-17.
[5]	Chao Gong, Shengyong Xu, Youlong Pan, Shigong Guo, Joseph Harold Walline, Xue Wang, Xin Lu, Shiyuan Yu, Mubing Qin, Huadong Zhu, Yanxia Gao, Yi Li. Effects of probiotic treatment on the prognosis of patients with sepsis: a systematic review [J]. World Journal of Emergency Medicine, 2025, 16(1): 18-27.
[6]	Jingyuan Xie, Jiandong Gao, Mutian Yang, Ting Zhang, Yecheng Liu, Yutong Chen, Zetong Liu, Qimin Mei, Zhimao Li, Huadong Zhu, Ji Wu. Prediction of sepsis within 24 hours at the triage stage in emergency departments using machine learning [J]. World Journal of Emergency Medicine, 2024, 15(5): 379-385.
[7]	Juexian Wei, Hengzong Mo, Yuting Zhang, Wenmin Deng, Siqing Zheng, Haifeng Mao, Yang Ji, Huilin Jiang, Yongcheng Zhu. Evolutionary trend analysis and knowledge structure mapping of endothelial dysfunction in sepsis: a bibliometrics study [J]. World Journal of Emergency Medicine, 2024, 15(5): 386-396.
[8]	Rex Pui Kin Lam, Zonglin Dai, Eric Ho Yin Lau, Carrie Yuen Ting Ip, Ho Ching Chan, Lingyun Zhao, Tat Chi Tsang, Matthew Sik Hon Tsui, Timothy Hudson Rainer. Comparing 11 early warning scores and three shock indices in early sepsis prediction in the emergency department [J]. World Journal of Emergency Medicine, 2024, 15(4): 273-282.
[9]	Huixin Zhao, Yiming Dong, Sijia Wang, Jiayuan Shen, Zhenju Song, Mingming Xue, Mian Shao. Comparison between sepsis-induced coagulopathy and sepsis-associated coagulopathy criteria in identifying sepsis-associated disseminated intravascular coagulation [J]. World Journal of Emergency Medicine, 2024, 15(3): 190-196.
[10]	A-ling Tang, Yan Li, Li-chao Sun, Xiao-yu Liu, Nan Gao, Sheng-tao Yan, Guo-qiang Zhang. Xuebijing improves intestinal microcirculation dysfunction in septic rats by regulating the VEGF-A/PI3K/Akt signaling pathway [J]. World Journal of Emergency Medicine, 2024, 15(3): 206-213.
[11]	Qing Zhao, Jinfu Ma, Jianguo Xiao, Zhe Feng, Hui Liu. Data driven analysis reveals prognostic genes and immunological targets in human sepsis-associated acute kidney injury [J]. World Journal of Emergency Medicine, 2024, 15(2): 91-97.
[12]	Weichao Ding, Wei Zhang, Juan Chen, Mengmeng Wang, Yi Ren, Jing Feng, Xiaoqin Han, Xiaohang Ji, Shinan Nie, Zhaorui Sun. Protective mechanism of quercetin in alleviating sepsis-related acute respiratory distress syndrome based on network pharmacology and in vitro experiments [J]. World Journal of Emergency Medicine, 2024, 15(2): 111-120.
[13]	Wei Zhou, Maiying Fan, Xiang Li, Fang Yu, En Zhou, Xiaotong Han. Molecular mechanism of Xuebijing in treating pyogenic liver abscess complicated with sepsis [J]. World Journal of Emergency Medicine, 2024, 15(1): 35-40.
[14]	Jingyi Wang, Li Weng, Jun Xu, Bin Du. Blood gas analysis as a surrogate for microhemodynamic monitoring in sepsis [J]. World Journal of Emergency Medicine, 2023, 14(6): 421-427.
[15]	Saifeng Chen, Xuewei Hao, Guo Chen, Guorong Liu, Xiaoyan Yuan, Peiling Shen, Dongfeng Guo. Effects of mesencephalic astrocyte-derived neurotrophic factor on sepsis-associated acute kidney injury [J]. World Journal of Emergency Medicine, 2023, 14(5): 386-392.