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

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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.

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Authors and Affiliations

  1. Emergency Medicine Research, Department of Emergency Medicine, Carolinas Medical Center, PO Box 32861, Charlotte, NC, 28232-2861, USA

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

Authors
  1. Michael R. Marchick
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  2. Jeffrey A. Kline
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  3. Alan E. Jones
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Corresponding author

Correspondence to Alan E. Jones.

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Marchick, M.R., Kline, J.A. & Jones, A.E. The significance of non-sustained hypotension in emergency department patients with sepsis. Intensive Care Med 35, 1261–1264 (2009). https://doi.org/10.1007/s00134-009-1448-x

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  • DOI: https://doi.org/10.1007/s00134-009-1448-x

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