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ORIGINAL RESEARCH article

Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 11 - 2024 | doi: 10.3389/fmed.2024.1446890

Association between delayed invasive blood pressure monitoring and all-cause mortality in intensive care unit patients with sepsis: a retrospective cohort study

Provisionally accepted
Li Xiao Li Xiao 1Pu Shen Pu Shen 1Xue Han Xue Han 2Yi Yu Yi Yu 3*
  • 1 The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
  • 2 The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
  • 3 Second Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China

The final, formatted version of the article will be published soon.

    Purpose: Haemodynamic management is essential in sepsis management. Invasive blood pressure (IBP) monitoring is the gold standard for blood pressure (BP) assessment. Here, we identified the most advantageous time frame for IBP monitoring to mitigate adverse outcomes in patients with sepsis. Methods: We included data on patients with sepsis from the Medical Information Mart for Intensive Care IV database. The primary endpoints comprised 28- and 90-day mortality rates, whereas secondary endpoints were acute kidney injury (AKI) rates and continuous renal replacement therapy (CRRT) requirement. To confirm our findings’ robustness, we performed multivariable Cox regression and logistic regression models, augmented by propensity score matching (PSM). Results: Of 18,326 patients hospitalised for sepsis, 9,056 (49.42%) and 9,270 (50.58%) were included in the early and delayed IBP-monitoring groups, respectively. Our multivariable Cox regression models revealed 20% and 21% significant increases in 28- and 90-day mortality in the delayed IBP monitoring group, respectively [hazard ratios (95% confidence intervals) = 1.20 (1.11–1.31) and 1.21 (1.12–1.31), respectively; both P < 0.001]. Moreover, significant increases were noted in AKI, CRRT and mechanical ventilation requirement risks in the delayed IBP monitoring group [odds ratios (95% confidence intervals) = 1.44 (1.34–1.56) , 1.50 (1.26–1.78) and 1.79 (1.67-1.92), respectively; both P < 0.001]. PSM further confirmed the validity of our findings. Delayed IBP monitoring prolonged intensive care unit (ICU) stay without extending vasopressor use duration. Conclusion: Prolonged delay in IBP monitoring (≥3 h) may increase mortality risks in ICU patients with sepsis. Nevertheless, early IBP monitoring may reduce AKI, CRRT and mechanical ventilation requirement risks and shorten ICU stay. However, these results warrant further validation through randomised controlled trials.

    Keywords: Invasive blood pressure, Intensive Care Unit, Sepsis, Mortality, Acute Kidney Injury

    Received: 10 Jun 2024; Accepted: 28 Oct 2024.

    Copyright: © 2024 Xiao, Shen, Han and Yu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Yi Yu, Second Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.