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The significance of non-sustained hypotension in emergency department patients with sepsis

Michael R Marchick, Jeffrey A Kline, Alan E Jones
Intensive Care Medicine 2009, 35 (7): 1261-4

OBJECTIVE: Few studies have documented the incidence and significance of non-sustained hypotension in emergency department (ED) patients with sepsis. We hypothesized that ED non-sustained hypotension increases risk of in-hospital mortality in patients with sepsis.

METHODS: Secondary analysis of a prospective cohort study. ED patients aged > 17 years admitted to the hospital with explicitly defined sepsis were prospectively identified.

INCLUSION CRITERIA: Evidence of systemic inflammation (> 1 criteria) and suspicion for infection. Patients with overt shock were excluded. The primary outcome was in-hospital mortality.

RESULTS: Seven hundred patients with sepsis were enrolled, including 150 (21%) with non-sustained hypotension. The primary outcome of in-hospital mortality was present in 10% (15/150) of patients with non-sustained hypotension compared with 3.6% (20/550) of patients with no hypotension. The presence of non-sustained hypotension resulted in three times the risk of mortality than no hypotension (risk ratio = 2.8, 95% CI 1.5-5.2). Patients with a lowest systolic blood pressure < 80 mmHg had a threefold increase in mortality rate compared with patients with a lowest systolic blood pressure > or = 80 mmHg (5 vs. 16%). In logistic regression analysis, non-sustained hypotension was an independent predictor of in-hospital mortality.

CONCLUSION: Non-sustained hypotension in the ED confers a significantly increased risk of death during hospitalization in patients admitted with sepsis. These data should impart reluctance to dismiss non-sustained hypotension, including a single measurement, as not clinically significant or meaningful.


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