PDF(Pubmed)
Abstract：
BACKGROUND: Preliminary evidence demonstrates that visit-to-visit systolic blood pressure (SBP) variability is a prognostic factor of TBI. However, literature regarding the impact of initial blood pressure management on the outcomes of TBI patients is limited. We aimed to further validate the clinical significance of BPV on the prognostic outcomes of patients with TBI.
METHODS: We performed the analysis by using individual patient-level data acquired from the eICU-CRD, which collected 200,859 ICU admissions of 139,367 patients in 2014 and 2015 from 208 US hospitals. Adult patients with traumatic intraparenchymal hemorrhage or contusion were included. The primary outcome was in-hospital mortality and the secondary outcome was discharge-home rate. Blood pressure variability (BPV) was calculated according to standard criteria: at least six measurements were taken in the first 24 h (hyperacute group) and 36 over days 2-7 (acute group). We estimated the associations between BPV and outcomes with logistic and proportional odds regression models. The key parameter for BPV was standard deviation (SD) of SBP, categorized into quintiles. We also calculated the average real variability (ARV), as well as maximum, minimum, and mean SBP for comparison in our analysis.
RESULTS: We studied 1486 patients in the hyperacute group and 857 in the acute group. SD of SBP had a significant association with the in-hospital mortality for both the hyperacute group (highest quintile adjusted OR 2.28 95% CI 1.18-4.42; ptrend<0.001) and the acute group (highest quintile adjusted OR 2.17, 95% CI 1.08-4.36; ptrend<0.001). The strongest predictors of primary outcome were SD of SBP in the hyperacute phase and minimum SBP in the acute phase. Associations were similar for the discharge-home rate (for the hyperacute group, highest quintile adjusted OR 0.58, 95% CI 0.37-0.89; ptrend<0.001; for the acute group OR 0.55, 95% CI 0.32-0.95; ptrend<0.001).
CONCLUSIONS: Systolic BPV seems to predict a poor outcome in patients with TBI. The benefits of early treatment to maintain appropriate SBP level might be enhanced by smooth and sustained control.
METHODS: We performed the analysis by using individual patient-level data acquired from the eICU-CRD, which collected 200,859 ICU admissions of 139,367 patients in 2014 and 2015 from 208 US hospitals. Adult patients with traumatic intraparenchymal hemorrhage or contusion were included. The primary outcome was in-hospital mortality and the secondary outcome was discharge-home rate. Blood pressure variability (BPV) was calculated according to standard criteria: at least six measurements were taken in the first 24 h (hyperacute group) and 36 over days 2-7 (acute group). We estimated the associations between BPV and outcomes with logistic and proportional odds regression models. The key parameter for BPV was standard deviation (SD) of SBP, categorized into quintiles. We also calculated the average real variability (ARV), as well as maximum, minimum, and mean SBP for comparison in our analysis.
RESULTS: We studied 1486 patients in the hyperacute group and 857 in the acute group. SD of SBP had a significant association with the in-hospital mortality for both the hyperacute group (highest quintile adjusted OR 2.28 95% CI 1.18-4.42; ptrend<0.001) and the acute group (highest quintile adjusted OR 2.17, 95% CI 1.08-4.36; ptrend<0.001). The strongest predictors of primary outcome were SD of SBP in the hyperacute phase and minimum SBP in the acute phase. Associations were similar for the discharge-home rate (for the hyperacute group, highest quintile adjusted OR 0.58, 95% CI 0.37-0.89; ptrend<0.001; for the acute group OR 0.55, 95% CI 0.32-0.95; ptrend<0.001).
CONCLUSIONS: Systolic BPV seems to predict a poor outcome in patients with TBI. The benefits of early treatment to maintain appropriate SBP level might be enhanced by smooth and sustained control.
摘要：
背景：初步证据表明访视收缩压（SBP）变异性是TBI的预后因素。然而,关于初始血压管理对TBI患者结局的影响的文献有限.我们旨在进一步验证BPV对TBI患者预后的临床意义。
方法：我们使用从eICU-CRD获得的个体患者水平数据进行分析，该研究收集了2014年和2015年来自208家美国医院的200,859名ICU住院患者139,367名患者。包括患有创伤性实质内出血或挫伤的成年患者。主要结局是住院死亡率，次要结局是出院率。根据标准标准计算血压变异性（BPV）：在前24小时（超急性组）和第2-7天（急性组）进行36次测量。我们用logistic和比例几率回归模型估计了BPV和结果之间的关联。BPV的关键参数是SBP的标准偏差(SD)，分为五分位数。我们还计算了平均实际变异性(ARV)，以及最大值，minimum,和平均SBP在我们的分析中进行比较。
结果：我们研究了超急性组1486例患者和急性组857例患者。超急性组(最高五分之一校正OR2.2895%CI1.18-4.42;ptrend<0.001)和急性组(最高五分之一校正OR2.17,95%CI1.08-4.36;ptrend<0.001)的SBPSD与住院死亡率均有显著关联。主要结局的最强预测因子是超急性期SBP的SD和急性期的最小SBP。出院回家率的关联相似(对于超急性组，经校正的最高五分位数OR0.58,95%CI0.37-0.89;ptrend<0.001;急性组OR0.55,95%CI0.32-0.95;ptrend<0.001)。
结论：收缩期BPV似乎可以预测TBI患者的不良预后。通过平稳和持续的控制，可以提高早期治疗以维持适当的SBP水平的益处。
方法：我们使用从eICU-CRD获得的个体患者水平数据进行分析，该研究收集了2014年和2015年来自208家美国医院的200,859名ICU住院患者139,367名患者。包括患有创伤性实质内出血或挫伤的成年患者。主要结局是住院死亡率，次要结局是出院率。根据标准标准计算血压变异性（BPV）：在前24小时（超急性组）和第2-7天（急性组）进行36次测量。我们用logistic和比例几率回归模型估计了BPV和结果之间的关联。BPV的关键参数是SBP的标准偏差(SD)，分为五分位数。我们还计算了平均实际变异性(ARV)，以及最大值，minimum,和平均SBP在我们的分析中进行比较。
结果：我们研究了超急性组1486例患者和急性组857例患者。超急性组(最高五分之一校正OR2.2895%CI1.18-4.42;ptrend<0.001)和急性组(最高五分之一校正OR2.17,95%CI1.08-4.36;ptrend<0.001)的SBPSD与住院死亡率均有显著关联。主要结局的最强预测因子是超急性期SBP的SD和急性期的最小SBP。出院回家率的关联相似(对于超急性组，经校正的最高五分位数OR0.58,95%CI0.37-0.89;ptrend<0.001;急性组OR0.55,95%CI0.32-0.95;ptrend<0.001)。
结论：收缩期BPV似乎可以预测TBI患者的不良预后。通过平稳和持续的控制，可以提高早期治疗以维持适当的SBP水平的益处。
