Performance differences among variations of systolic, diastolic, and mean arterial pressures in prognosticating mortality in critically Ill patients who are taking norepineprine

Abstract EN

Objective: Systolic blood pressure, diastolic blood pressure, and the mean arterial blood pressure are useful markers that can predict morbidity and mortality among critically ill patients and may be used to predict the prognosis of patients with septic shock.

Our objective was to compare the ability of percentage variations of the systolic, diastolic, and mean arterial pressures (%SBPvar, %MAPvar, and %DBPvar) to predict the primary outcome of overall 28-day intensive care unit mortality, and the secondary outcomes of early mortality (≤14 days), late mortality (>14 days), and intensive care unit length of stay.

Methods: We performed a retrospective analysis of 163 patients admitted to our adult critical care unit between April 2017 and Sep 2018 who met the inclusion criteria of availability of all required data and who survived or discharged before completing at least 1 week of admission.

Independent T-test, Mann Whitney U test, and chi square test were used to express all patient variables.

A receiver operating char- acteristic curve (ROC) followed by sensitivity analysis was generated to determine the predictive performances, and the optimal cut-off values for three propose prognosticators.

Results: The mean overall age was 58.37±9.96 years.

112 subjects (68.71%) were male and 51 subjects (31.29%) were female.

The overall 28-day, early, and late ICU mortality rate were 39.26% (64 patients), 9.82% (16 patients), and 29.45% (48 patients), respectively.

Our studied three prognosticators of %SBPvar, %MAPvar, and %DBPvar were significantly lower in survivors in compared with non survivors (8.96%±0.26%, 16.34%±0.65%, and 22.52%±1.10% versus 11.04%±4.61%, 21.17%±7.54%, and 35.18%±29.37%, respectively).

The area under curve of ROC %MAPvar (0.818) was significantly greater than those of %SBPvar (0.769) and %DBPvar (0.265).

Conclusion: In summary, %MAPvar and %SBPvar prognosticators were an effective, no-cost bedside modalities, and discriminative prognosticators with realistic, reliable, and readily available red flag bedside assessment tools which had high sensitivity, performance, and accuracy to predict early, late, and overall 28-day ICU mortality in septic mechanically ventilated critically ill patients who were receiving norepinephrine as a vasopressor.