A widened pulse pressure: a potential valuable prognostic indicator of mortality in patients with sepsis

Al-Khalisy, Hassan; Nikiforov, Ivan; Jhajj, Manjit; Kodali, Namratha; Cheriyath, Pramil

doi:10.3402/jchimp.v5.29426

Cited by 9 publications

(6 citation statements)

References 18 publications

(19 reference statements)

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“…While not universally present, wide PP is a common feature alongside Corrigan's pulse, Traube's sign, and Quincke's pulse 36,37 . A wide PP is a common feature of early distributive shock 38,39 and may even be a predictor of mortality and fluid responsiveness 40 . Elevated intracranial pressure (ICP) should also be on the differential, as wide PP may be a finding in the classical Cushing triad response.…”

Section: Differential Diagnosismentioning

confidence: 99%

Wide pulse pressure: A clinical review

Tang

Medeiros

Shah

2020

J of Clinical Hypertension

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Pulse pressure naturally increases over time as individuals’ age due to arteriosclerosis and diffuse vascular stiffening. However, the differential for widened pulse pressure is broad and includes causes of hyperdynamic circulation and high‐output heart failure, such as aortic regurgitation and hyperthyroidism. In the absence of an underlying cause, wide pulse pressure is a sign of deteriorating cardiovascular health and carries increased risk for mortality, disease progression, and adverse clinical outcomes in chronic diseases including cardiovascular disease and chronic kidney disease. Current emphasis of antihypertensive treatment on systolic and diastolic blood pressure does not always address pulse pressure, thus subjecting many patients to an independent risk factor for poor outcomes. Pulse pressure control is more successfully achieved with thiazide diuretics and long‐acting nitrates when compared to other antihypertensive agents, but further research is needed to quantify the additional benefits of pulse pressure control over conventional blood pressure therapy. This case review provides an overview of the pathogenesis, pathologic causes, and treatment of widened pulse pressure and evaluates current evidence for pulse pressure as a predictor of clinical outcomes.

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Section: Differential Diagnosismentioning

confidence: 99%

Wide pulse pressure: A clinical review

Tang

Medeiros

Shah

2020

J of Clinical Hypertension

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“…Which is consistent with our finding of considering the pulse pressure as an independent variable from which both statistical and dynamic features can be extracted to inform mortality prediction. Moreover, the medical study in Reference [37] concludes the relevance between the widened (high) pulse pressure and the mortality risk for a special profile of critically ill patients. This conclusion as well is consistent with our finding, as we referred to the statistical and dynamic features of the pulse pressure which will indicate either abnormally high or low levels of pulse pressure.…”

Section: Discussionmentioning

confidence: 99%

Feature Engineering for ICU Mortality Prediction Based on Hourly to Bi-Hourly Measurements

et al. 2019

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Mortality prediction for intensive care unit (ICU) patients is a challenging problem that requires extracting discriminative and informative features. This study presents a proof of concept for exploring features that can provide clinical insight. Through a feature engineering approach, it is attempted to improve ICU mortality prediction in field conditions with low frequently measured data (i.e., hourly to bi-hourly). Features are explored by investigating the vital signs measurements of ICU patients, labelled with mortality or survival at discharge. The vital signs of interest in this study are heart and respiration rate, oxygen saturation and blood pressure. The latter comprises systolic, diastolic and mean arterial pressure. In the feature exploration process, it is aimed to extract simple and interpretable features that can provide clinical insight. For this purpose, a classifier is required that maximises the margin between the two classes (i.e., survival and mortality) with minimum tolerance to misclassification errors. Moreover, it preferably has to provide a linear decision surface in the original feature space without mapping to an unlimited dimensionality feature space. Therefore, a linear hard margin support vector machine (SVM) classifier is suggested. The extracted features are grouped in three categories: statistical, dynamic and physiological. Each category plays an important role in enhancing classification error performance. After extracting several features within the three categories, a manual feature fine-tuning is applied to consider only the most efficient features. The final classification, considering mortality as the positive class, resulted in an accuracy of 91.56 % , sensitivity of 90.59 % , precision of 86.52 % and F 1 -score of 88.50 % . The obtained results show that the proposed feature engineering approach and the extracted features are valid to be considered and further enhanced for the mortality prediction purpose. Moreover, the proposed feature engineering approach moved the modelling methodology from black-box modelling to grey-box modelling in combination with the powerful classifier of SVMs.

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“…High PP is a strong predictor of cardiovascular morbidity/mortality in the geriatric population and among patients with hypertension, coronary heart disease, diabetes mellitus, and renal disease [16][17][18][19][20]. However, there is a paucity of studies about the prognostic value of PP in regards to mortality of patients with sepsis, especially among patients administered a resuscitation therapy bundle including maintaining MAP at > 65 mmHg [21].…”

Section: Discussionmentioning

confidence: 99%

Pulse pressure during the initial resuscitative period in patients with septic shock treated with a protocol-driven resuscitation bundle therapy

Lee

Kim

et al. 2020

Korean J Intern Med

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Background/Aims: Maintaining a mean arterial pressure (MAP) ≥ 65 mmHg during septic shock should be based on individual circumstances, but specific target is poorly understood. We investigated associations between time-weighted average (TWA) hemodynamic parameters during the initial resuscitative period and 28-day mortality. Methods: Prospectively collected data were obtained from a septic shock patient registry, according to the Sepsis-3 definition, between 2016 and 2018. The TWA systolic blood pressure, diastolic blood pressure, MAP, shock index, and pulse pressure (PP) during the first 6 hours after shock recognition were compared. Multivariable regression analysis was performed to assess associations between these parameters and 28-day mortality. Results: Of 340 patients with septic shock, 92 died. Only the median TWA PP differed between the survivors and non-survivors (39.2 mmHg vs. 43.0 mmHg, p = 0.020), whereas the other indexes did not. When PP was divided into quartiles (< 34, 34 to 40, 40 to 48, and > 48 mmHg), the mortality rate was higher in the highest quartile (41.2%). Multivariable logistic analysis revealed that PP (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.012 to 1.622; p = 0.039) and PP of > 48 mmHg (OR, 2.25; 95% CI, 1.272 to 3.981; p = 0.005) were independently associated with 28day mortality. Conclusions: PP was significantly associated with 28-day mortality in patients with septic shock and MAP maintained at > 65 mmHg during the first 6 hours. Further studies are warranted to optimize strategies for maintaining PP and MAP at > 65 mmHg during the early resuscitative period.

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A widened pulse pressure: a potential valuable prognostic indicator of mortality in patients with sepsis

Cited by 9 publications

References 18 publications

Wide pulse pressure: A clinical review

Wide pulse pressure: A clinical review

Feature Engineering for ICU Mortality Prediction Based on Hourly to Bi-Hourly Measurements

Pulse pressure during the initial resuscitative period in patients with septic shock treated with a protocol-driven resuscitation bundle therapy

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