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Open Access 01-12-2018 | Research

Mean arterial pressure and mortality in patients with distributive shock: a retrospective analysis of the MIMIC-III database

Authors: Jean-Louis Vincent, Nathan D. Nielsen, Nathan I. Shapiro, Margaret E. Gerbasi, Aaron Grossman, Robin Doroff, Feng Zeng, Paul J. Young, James A. Russell

Published in: Annals of Intensive Care | Issue 1/2018

Abstract

Background

Maintenance of mean arterial pressure (MAP) at levels sufficient to avoid tissue hypoperfusion is a key tenet in the management of distributive shock. We hypothesized that patients with distributive shock sometimes have a MAP below that typically recommended and that such hypotension is associated with increased mortality.

Methods

In this retrospective analysis of the Medical Information Mart for Intensive Care (MIMIC-III) database from Beth Israel Deaconess Medical Center, Boston, USA, we included all intensive care unit (ICU) admissions between 2001 and 2012 with distributive shock, defined as continuous vasopressor support for ≥ 6 h and no evidence of low cardiac output shock. Hypotension was evaluated using five MAP thresholds: 80, 75, 65, 60 and 55 mmHg. We evaluated the longest continuous episode below each threshold during vasopressor therapy. The primary outcome was ICU mortality.

Results

Of 5347 patients with distributive shock, 95.7%, 91.0%, 62.0%, 36.0% and 17.2%, respectively, had MAP < 80, < 75, < 65, < 60 and < 55 mmHg for more than two consecutive hours. On average, ICU mortality increased by 1.3, 1.8, 5.1, 7.9 and 14.4 percentage points for each additional 2 h with MAP < 80, < 75, < 65, < 60 and < 55 mmHg, respectively. Multivariable logistic modeling showed that, compared to patients in whom MAP was never < 65 mmHg, ICU mortality increased as duration of hypotension < 65 mmHg increased [for > 0 to < 2 h, odds ratio (OR) 1.76, p = 0.005; ≥ 6 to < 8 h, OR 2.90, p < 0.0001; ≥ 20 h, OR 7.10, p < 0.0001]. When hypotension was defined as MAP < 60 or < 55 mmHg, the associations between duration and mortality were generally stronger than when hypotension was defined as MAP < 65 mmHg. There was no association between hypotension and mortality when hypotension was defined as MAP < 80 mmHg.

Conclusions

Within the limitations due to the nature of the study, most patients with distributive shock experienced at least one episode with MAP < 65 mmHg lasting > 2 h. Episodes of prolonged hypotension were associated with higher mortality.

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Title: Mean arterial pressure and mortality in patients with distributive shock: a retrospective analysis of the MIMIC-III database
Authors: Jean-Louis Vincent
Nathan D. Nielsen
Nathan I. Shapiro
Margaret E. Gerbasi
Aaron Grossman
Robin Doroff
Feng Zeng
Paul J. Young
James A. Russell
Publication date: 01-12-2018
Publisher: Springer International Publishing
Published in: Annals of Intensive Care / Issue 1/2018
Electronic ISSN: 2110-5820
DOI: https://doi.org/10.1186/s13613-018-0448-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Mean arterial pressure and mortality in patients with distributive shock: a retrospective analysis of the MIMIC-III database

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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