Deans' stroke musings: Increased variability of mean arterial pressure is associated with increased risk of short-term mortality in intensive care unit: A retrospective study

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, October 13, 2022

Increased variability of mean arterial pressure is associated with increased risk of short-term mortality in intensive care unit: A retrospective study

For stroke patients, what is the protocol that will prevent this increased mortality? Your hospital probably should have been working on solving this problem for decades.

Increased variability of mean arterial pressure is associated with increased risk of short-term mortality in intensive care unit: A retrospective study

Jia Yao¹^†,

Dandan Liu¹^†,

Weifeng Huang²,

Yuexin Fang¹,

Yifan Yang¹,

Yingchuan Li²,

Pengyuan Liu³^* and

Xiaoqing Pan¹^*

¹Department of Mathematics, Shanghai Normal University, Shanghai, China
²Department of Critical Care Medicine, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
³Department of Respiratory Medicine, Sir Run Run Shaw Hospital and Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, China

Background: In intensive care unit (ICU), what thresholds of MAP variability are effective in distinguishing low- and high-risk patients for short-term mortality (in-hospital and 28-day) remains unclear.

Methods: Fifteen thousand five hundred sixty adult subjects admitted to ICU at Beth Israel Deaconess Medical Center (Boston, USA) between 2001 and 2012 were included in this retrospective study from MIMIC-III database. MAP within the first 24 h after admission were collected. Quantiles of MAP variability from 10% to 90% with 10% increasement each were considered to divide study participants into two groups, either having coefficients of variation of MAP greater or less than the given threshold. The threshold of MAP variability was identified by maximizing the odds ratio associated with increased risk of short-term mortality (in-hospital and 28-day). Logistic regression and Cox regression models were further applied to evaluate the association between increased variability of MAP and short-term mortality (in-hospital and 28-day).

Results: 90% quantile of MAP variability was determined as the threshold generating the largest odds ratio associated with the increased risk of short-term mortality. Increased MAP variability, especially over 90% of MAP variability, was associated with increased risk of in-hospital mortality (odds ratio: 2.351, 95% CI: 2.064–2.673), and 28-day mortality (hazard ratio: 2.064, 95% CI: 1.820–2.337).

Conclusion: Increased MAP variability, especially over 90% of MAP variability, is associated with short-term mortality. Our proposed threshold of MAP variability may aid in the early identification of critically ill patients with a high risk of mortality.

Introduction

Blood pressure (BP) is a fundamental physiological variable monitored in intensive care medicine. The variation of BP arises naturally because BP is influenced by biological, behavioral, emotional, and environmental factors and their complex interactions (1–5). The increased variation of BP has been reported to be associated with various organ injuries, high risks of cardiovascular and cerebrovascular events, and mortality, as it reflects sympathetic activation and impairment of baroceptive reflexes (6–9).

BP variation is a continuous phenotype, mainly divided into short-term (minutes to hours) and long-term (days and months) variation. Both short- and long-term blood pressure variability independently increased the risk of death in hypertensive patients as well as in patients with diabetes and chronic kidney disease (10–12). Critically ill patients are often accompanied by high incidence of anxiety, delirium, sleep deprivation, central, and autonomic dysregulation during intensive care unit (ICU) (13), which may contribute to increased BP variation, especially short-term BP variation. Increased short-term BP variability is known to adversely affect patients with chronic diseases, however the extent to which increased short-term BP variability increases the risk of in-hospital mortality in critically ill patients in the ICU remains to be further investigated.

Circadian rhythm of mean arterial pressure (MAP) is recommended for assessing the prognosis of patients admitted to ICU in the clinical setting (14, 15). Although accumulating evidence also indicated that increased BP variability was independently associated with higher risk of target-organ damage, cardiovascular event, and mortality (11, 13, 16–18), little was known about the threshold at which MAP variability is high enough to have clinical significance in critically ill patients. In this study, we hypothesized that increased MAP variability is associated with short-term mortality and further proposed a threshold of MAP variability to aid early identification of critically ill patients at a high risk of mortality.