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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
  1. Mats Warmerdam1,
  2. Lucia Baris1,
  3. Margo van Liebergen1,
  4. Annemieke Ansems2,
  5. Laura Esteve Cuevas2,
  6. Merel Willeboer2,
  7. Douwe Rijpsma3,
  8. Amith L Shetty4,
  9. Bas de Groot1
  1. 1 Department of Emergency Medicine, Leiden University Medical Center, Leiden, The Netherlands
  2. 2 Department of Emergency Medicine, Albert Schweitzer Ziekenhuis, Dordrecht, Zuid-Holland, The Netherlands
  3. 3 Department of Emergency Medicine, Rijnstate Ziekenhuis, Arnhem, The Netherlands
  4. 4 Department of Emergency Medicine, Westmead Hospital, Sydney, New South Wales, Australia
  1. Correspondence to Dr. Bas de Groot, Department of Emergency Medicine, Leiden University Medical Center, Leiden 2300 RC, The Netherlands; b.de_groot.SEH{at}lumc.nl

Abstract

Objective In existing risk stratification and resuscitation guidelines for sepsis, a hypotension threshold of systolic blood pressure (SBP) below 90–100 mmHg is typically used. However, for older patients, the clinical relevance of a SBP in a seemingly ‘normal’ range (>100 mmHg) is still poorly understood, as they may need higher SBP for adequate tissue perfusion due to arterial stiffening. We therefore investigated the association between SBP and mortality in older emergency department (ED) patients hospitalised with a suspected infection.

Methods In this observational multicentre study in the Netherlands, we interrogated an existing prospective database of consecutive ED patients hospitalised with a suspected infection between 2011 and 2016. We investigated the association between SBP categories (≤100, 101–120, 121–139, ≥140 mmHg) and in-hospital mortality in patients of 70 years and older. We adjusted for demographics, comorbidity, disease severity and admission to ward/intensive care using multivariable logistic regression.

Results In the 833 included older patients, unadjusted in-hospital mortality increased from 4.7% (n=359) in SBP ≥140 mmHg to 20.8% (n=96) in SBP ≤100 mmHg. SBP categories were linearly associated with case-mix-adjusted in-hospital mortality. The adjusted ORs (95% CI) for ≤100, 101–120 and 121–139 mmHgcompared with the reference of ≥140 mmHg were 3.8 (1.8 to 7.8), 2.8 (1.4 to 5.5) and 1.9 (0.9 to 3.7), respectively.

Conclusion In older ED patients hospitalised with a suspected infection, we found an inverse linear association between SBP and case-mix-adjusted in-hospital mortality. Our data suggest that the commonly used threshold for hypotension is not clinically meaningful for risk stratification of older ED patients with a suspected infection.

  • aged
  • emergency department
  • geriatrics
  • infectious diseases
  • risk management

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Footnotes

  • Contributors BdG devised and designed the study, collected the data, contributed to the analyses and edited the manuscript. MW collected the data, did the analyses and wrote the manuscript. LB, MvL, MW, AA and LEC collected the data and edited the manuscript. DR and ALS edited the manuscript. BdG takes full responsibility for the study as a whole. All authors have read and approved the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The study was approved by the medical ethics committee of the LUMC, which waived the need for individual consent because of the purely observational characteristics of the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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