Blood pressure variability as an indicator of sepsis severity in adult emergency department patients - 27/09/17

Doi : 10.1016/j.ajem.2017.09.017

Jacob E. Nouriel, BA ^a,^{^⁎} , Scott R. Millis, PhD ^b, Jonathon Ottolini, BA ^a, John M. Wilburn, MD ^a, Robert L. Sherwin, MD ^a, James H. Paxton, MD, MBA ^a
^a Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
^b Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA

^⁎Corresponding author at: Wayne State University School of Medicine, 540 E. Canfield St., Detroit, MI 48201, USA.Wayne State University School of Medicine540 E. Canfield St.DetroitMI48201USA

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 27 September 2017
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Abstract

Study objective

Quantify the correlation between blood pressure variability (BPV) and markers of illness severity: serum lactate (LAC) or Sequential Organ Failure Assessment (SOFA) scores.

Methods

We performed a secondary analysis of data from a prospective, observational study evaluating fluid resuscitation on adult, septic, ED patients. Vital signs and fluid infusion volumes were recorded every 15min during the 3h following ED arrival. BPV was assessed via average real variability (ARV): the average of the absolute differences between consecutive BP measurements. ARV was calculated for the time periods before and after 3 fluid infusion milestones: 10-, 20-, and 30-mL/kg total body weight (TBW). Spearman's rho correlation coefficient analysis was utilized. A p-value<0.05 was considered statistically significant.

Results

Forty patients were included. Mean fluid infusion was 33.7mL/kg TBW (SD 22.1). All patients received fluid infusion≥10mL/kg TBW, 25 patients received fluid infusion>20mL/kg TBW, and 16 patients received fluid infusion>30mL/kg TBW. Mean initial LAC was 4.0mmol/L (SD 3.2). Mean repeat LAC was 3.1mmol/L (SD 3.2), obtained an average of 6.6h (SD 5.3) later. Mean SOFA score was 7.0 (SD 4.4). BPV correlated with both follow-up LAC (r=0.564; p=0.023) and SOFA score (r=0.544; p=0.024) among the cohort that received a fluid infusion>20-mL/kg TBW.

Conclusion

With the finding of a positive correlation between BPV and markers of illness severity (LAC and SOFA scores), this pilot study introduces BPV analysis as a real-time, non-invasive tool for continuous sepsis monitoring in the ED.

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Abbreviations : ARV, BP, BPV, HRV, LAC

Keywords : Sepsis, Hemodynamic monitoring, Fluid resuscitation

Plan

☆	Funding: Funding for this study was provided by Wayne State University School of Medicine and Vidacare/Teleflex Corporation.
☆☆	Conflicts of interests: There are no conflicts of interest for the primary author or any of the co-authors.
★	Prior abstract publication/presentation: This research has been presented (abstract) at the 2017 meeting for the Society of Critical Care Medicine, Honolulu, Hawaii, on January 23, 2017.