Systolic Blood Pressure Trajectory May Influence In-Hospital Mortality Risk in Sepsis

Systolic blood pressure (BP) maintained at a measurement of approximately 140 mm Hg for the first 10 hours of hospitalization for sepsis was associated with decreased risk of in-hospital mortality, according to findings published in BMC Infectious Disease.

This retrospective cohort included data captured from patients hospitalized with sepsis between 2008 and 2019. Researchers sought to identify the relationship between systolic BP trajectories and the risk of in-hospital mortality via latent growth mixture modeling. Cox proportional hazards regression was used to determine the connection between 7 different trajectory classes and in-hospital mortality risk.

Among a total of 3034 patients included in the study, the majority were men (57%), the median age was 67 years, and the overall rate of in-hospital mortality was 23.3%. Systolic BP measurements for the 7 trajectory classes ranged from 82 to 160 mm Hg and higher.

The highest in-mortality risk was observed among patients with systolic BP measurements in class 2 (~82 mm Hg; P <.005), and the lowest risk was observed among patients with systolic BP measurements in class 3 (~140 mm Hg; P =.009). Log-rank testing results showed that the probability of survival significantly differed among the 7 trajectory classes (P <.001).

In subgroup analyses, no significant associations were observed between systolic blood pressure trajectory and in-hospital mortality risk on the basis of patient sex, congestive heart failure, cerebrovascular disease, and chronic pulmonary disease. However, a nominal association was observed for patient age (P <.005).

The researchers noted an increased risk of in-hospital mortality for systolic BP measured as either persistently low or high when compared with those maintained at approximately 140 mm Hg. 

Limitations of this study include the single-center retrospective design, potential survivorship bias, and the effect unmeasured variables may have had on systolic BP measurements, such as vasopressor use and hypertension history.

Based on these findings, “The trend of SBP [systolic blood pressure] in patients should therefore be closely observed, and corresponding treatment should be provided as soon as possible to improve their prognoses,” the researchers concluded.