Mean arterial pressure within 24 hours of admission predicts short-term prognosis in patients with intermediate-risk and high-risk pulmonary embolism

Abstract

OBJECTIVEPulmonary embolism is a terrible cardiovascular condition with considerable morbidity and mortality.Previous studies have investigated that systolic blood pressure(Systolic BP)and diastolic blood pressure(Diastolic BP) were related to 30-day and in-hospital mortality.We aimed to determine if the average mean arterial pressure(aMAP) in the first 24 hours of hospital admission is useful to predict short-term outcomes of intermediate-risk and high-risk PE patients.MethodWe conducted a single center retrospective study.From May 2012 and April 2019, 122 intermediate-risk and high-risk PE patients were included.The primary outcome was in-hospital mortality.The secondary outcome was adverse events.ROC curves and cut-off values for aMAP predicting in-hospital-death were computed.According to cut-off values,we categorize five groups defined as followed:group 1:aMAP<70mmHg;group2:70mmHg≤aMAP<80mmHg;group3:80mmHg≤aMAP<90mmHg;group4:90mmHg≤aMAP<100mmHg;group5:aMAP≥100mmHg.Cox regression models were calculated to investigate associations between aMAP and in-hospital-death.ResultIn the study group of 122 patients,15 patients (12.30%) died in hospital due to PE.ROC analysis for MAP predicting in-hospital-death revealed an AUC of 0.729 with cut-off value of 79.4mmHg.Cox regression models showed a significant association between in-hospital death and aMAP group1(Ref),aMAP group2(OR1.680,95CI%0.020-140.335),aMAPgroup3(OR0.003,95CI%0.0001-0.343),aMAPgroup4(OR0.006,95CI%0.0001-1.671),aMAPgroup5(OR0.003,95%CI0.0001-9.744. It is aMAP 80-90mmHg that suffer from minimum adverse events ConclusionPrognostic role of MAP at the first 24 hours of hospital admission should be emphasized in patients with PE.80 to 90mmHg may be the optimal range of MAP for intermediate-risk and high-risk PE patients.