The association between systolic blood pressure and in-hospital mortality in older emergency department patients who are hospitalised with a suspected infection

Warmerdam, Mats; Baris, Lucia; Liebergen, Margo van; Ansems, Annemieke; Cuevas, Laura Esteve; Willeboer, Merel; Rijpsma, Douwe; Shetty, Amith; Groot, Bas de

doi:10.1136/emermed-2018-207502

Cited by 13 publications

(5 citation statements)

References 9 publications

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“…Significant hypotension was defined as a systolic blood pressure of less than 100mmHg based on clinical data showing an increased mortality below this level and consensus guidelines from the European Society of Intensive Care Medicine. [19][20][21] The total number of blood pressure recordings taken during admission, prior to palliation, and the number of readings with a systolic value of less than 100mmHg were recorded. The proportion of hypotensive recordings compared to the total was calculated from this.…”

Section: Hypotensionmentioning

confidence: 99%

Inpatient Omission of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Is Associated With Morbidity and Mortality in Coronavirus Disease 2019

Oddy

Allington

McCaul

et al. 2021

Clinical Therapeutics

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: Hypotensionmentioning

confidence: 99%

Inpatient Omission of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Is Associated With Morbidity and Mortality in Coronavirus Disease 2019

Oddy

Allington

McCaul

et al. 2021

Clinical Therapeutics

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“…Many risk stratification tools, such as the Systemic Inflammatory Response Syndrome ( SIRS), Quick Sequential Organ Failure Assessment (qSOFA) and CURB-65 scores,2 5–8 specify a single cut-off (or threshold) for each of the commonly measured vital signs, suggesting that one cut-off may discriminate between good and bad prognosis. However, recent studies in patients with traumatic brain injury and sepsis showed that prognosis linearly worsened with decreasing systolic blood pressure (SBP), without an identifiable single threshold 9 10. Similarly, linear or U-shaped instead of dichotomous associations may exist for other vital signs used in ED risk stratification.…”

Section: Introductionmentioning

confidence: 99%

The association between vital signs and clinical outcomes in emergency department patients of different age categories

et al. 2022

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BackgroundAppropriate interpretation of vital signs is essential for risk stratification in the emergency department (ED) but may change with advancing age. In several guidelines, risk scores such as the Systemic Inflammatory Response Syndrome (SIRS) and Quick Sequential Organ Failure Assessment (qSOFA) scores, commonly used in emergency medicine practice (as well as critical care) specify a single cut-off or threshold for each of the commonly measured vital signs. Although a single cut-off may be convenient, it is unknown whether a single cut-off for vital signs truly exists and if the association between vital signs and in-hospital mortality differs per age-category.AimsTo assess the association between initial vital signs and case-mix adjusted in-hospital mortality in different age categories.MethodsObservational multicentre cohort study using the Netherlands Emergency Department Evaluation Database (NEED) in which consecutive ED patients ≥18 years were included between 1 January 2017 and 12 January 2020. The association between vital signs and case-mix adjusted mortality were assessed in three age categories (18-65; 66-80; >80 years) using multivariable logistic regression. Vital signs were each divided into five to six categories, for example, systolic blood pressure (SBP) categories (≤80, 81–100, 101–120, 121–140, >140 mm Hg).ResultsWe included 101 416 patients of whom 2374 (2.3%) died. Adjusted ORs for mortality increased gradually with decreasing SBP and decreasing peripheral oxygen saturation (SpO2). Diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR) had quasi-U-shaped associations with mortality. Mortality did not increase for temperatures anywhere in the range between 35.5°C and 42.0°C, with a single cut-off around 35.5°C below which mortality increased. Single cut-offs were also found for MAP <70 mm Hg and respiratory rate >22/min. For all vital signs, older patients had larger increases in absolute mortality compared with younger patients.ConclusionFor SBP, DBP, SpO2 and HR, no single cut-off existed. The impact of changing vital sign categories on prognosis was larger in older patients. Our results have implications for the interpretation of vital signs in existing risk stratification tools and acute care guidelines.

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“…A study by a group from the Netherlands suggests that patients above the age of 70 with suspected infection experience under-rescucitation, and this was correlated to increased mortality [27]. An inverse correlation between mortality and initial systolic blood pressure (SBP) was noted in the same age group at SBPs of 100-140mm Hg [28]. This is somewhat contrary to a study of mostly geriatric patients with sepsis who received early resuscitation upon paramedic contact that found mortality benefit was largely limited to patients with SBP below 100 mmHg [14].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Fluid Resuscitation Timeliness in Geriatric Patients with Sepsis: A Single Center Retrospective Cohort Study

2022

International Journal of Anesthesia and Critical Care

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Background: Crystalloid bolus administration remains a cornerstone of sepsis management. Studies indicate that geriatric patients with sepsis benefit from guideline-recommended bundles. The effect of fluid timeliness on patient-centered outcomes in geriatric patients with sepsis is unknown. We conducted a retrospective cohort study to assess association between time-to-crystalloid and composite mortality and discharge to hospice. Hospital length of stay (LOS), ICU LOS, ICU admission and intubation rate were investigated secondarily. These outcomes were compared in prespecified prompt (< 60 minutes), early (60-180 minutes), and late ( >180 minutes) resuscitation groups, and within the cohort as a whole.Results: 225 patients were included in this study. 46.2% received crystalloid before 60 minutes, while 40.9% and 12.9% of patients were resuscitated within 60-180 minutes and greater than 180 minutes, respectively. Baseline characteristics in all three groups were similar. There was no difference in composite in-hospital mortality or hospice discharge [27 (26.2%) vs. 24 (26.4%) vs. 10 (34.5%); p=0.653] between the three groups. The late crystalloid administration group had statistically significant longer ICU LOS [2.35 (3.99) vs. 3.82 (6.42) vs 6.14 (7.31); p=0.014] and increased intubation rate [6 (5.8) vs. 6 (6.5) vs. 6(20.7); p=0.026]. Regression analyses indicated that time-to-crystalloid directly correlated with hospital LOS, ICU LOS and intubation rate.Conclusions: In this hypothesis-generating cohort study of geriatric patients with sepsis, there was no association between time-to-crystalloid and composite in-hospital mortality or hospice discharge.

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The association between systolic blood pressure and in-hospital mortality in older emergency department patients who are hospitalised with a suspected infection

Cited by 13 publications

References 9 publications

Inpatient Omission of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Is Associated With Morbidity and Mortality in Coronavirus Disease 2019

Inpatient Omission of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Is Associated With Morbidity and Mortality in Coronavirus Disease 2019

The association between vital signs and clinical outcomes in emergency department patients of different age categories

The Impact of Fluid Resuscitation Timeliness in Geriatric Patients with Sepsis: A Single Center Retrospective Cohort Study

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