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

Michael R. Marchick, Jeffrey A. Kline, Alan E. Jones

Research output: Contribution to journalArticle

54 Scopus citations

Abstract

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 ≥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.

Original languageEnglish (US)
Pages (from-to)1261-1264
Number of pages4
JournalIntensive Care Medicine
Volume35
Issue number7
DOIs
StatePublished - Jul 1 2009
Externally publishedYes

Keywords

  • Emergency medicine
  • Hypotension
  • Mortality
  • Sepsis
  • Shock

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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