PurposeCurrent guidelines recommend maintaining a mean arterial pressure (MAP) ≥ 65 mmHg in septic patients. However, the relationship between hypotension and major complications in septic patients remains unclear. We, therefore, evaluated associations of MAPs below various thresholds and in-hospital mortality, acute kidney injury (AKI), and myocardial injury.MethodsWe conducted a retrospective analysis using electronic health records from 110 US hospitals. We evaluated septic adults with intensive care unit (ICU) stays ≥ 24 h from 2010 to 2016. Patients were excluded with inadequate blood pressure recordings, poorly documented potential confounding factors, or renal or myocardial histories documented within 6 months of ICU admission. Hypotension exposure was defined by time-weighted average mean arterial pressure (TWA-MAP) and cumulative time below 55, 65, 75, and 85 mmHg thresholds. Multivariable logistic regressions determined the associations between hypotension exposure and in-hospital mortality, AKI, and myocardial injury.ResultsIn total, 8,782 patients met study criteria. For every one unit increase in TWA-MAP < 65 mmHg, the odds of in-hospital mortality increased 11.4% (95% CI 7.8%, 15.1%, p < 0.001); the odds of AKI increased 7.0% (4.7, 9.5%, p < 0.001); and the odds of myocardial injury increased 4.5% (0.4, 8.7%, p = 0.03). For mortality and AKI, odds progressively increased as thresholds decreased from 85 to 55 mmHg.ConclusionsRisks for mortality, AKI, and myocardial injury were apparent at 85 mmHg, and for mortality and AKI risk progressively worsened at lower thresholds. Maintaining MAP well above 65 mmHg may be prudent in septic ICU patients.Electronic supplementary materialThe online version of this article (10.1007/s00134-018-5218-5) contains supplementary material, which is available to authorized users.
shown that the coating impairs bioavailability and results in slower and less predictable antiplatelet activity compared with regular aspirin. The lack of definitive clinical trials demonstrating that the use of enteric-coated aspirin delivers the same efficacy as regular aspirin supplements the uncertainty. In fact, multiple recently published trials with enteric-coated aspirin failed to show benefit while showing increased GI bleeding. It therefore seems that adding a delayed-release coating to aspirin failed to deliver a safer next generation agent and may have jeopardized the ability to block platelets and prevent CV events. As such, a great unmet need remains for an alternative formulation with a safer GI profile and uncompromised antiplatelet activity.
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