Nonsustained Hypotension May Be Red Flag in Sepsis Treatment

NEW ORLEANS — Nonsustained hypotension in emergency department patients with sepsis was associated with a threefold increased rate of in-hospital mortality in a large prospective study.

“Clinicians should consider any hypotension in the setting of sepsis to herald worse outcome. This knowledge should impart reluctance to dismiss nonsustained hypotension—including a single measurement—as not clinically significant or meaningful,” Dr. Michael Marchick said at the annual meeting of the Society for Academic Emergency Medicine.

Dr. Marchick reported on a randomly obtained single-center study population consisting of 700 adults hospitalized with a primary diagnosis of sepsis. None had clinically overt shock as defined by need for vasopressors in the ED or systolic blood pressure below 100 mm Hg sustained for 1 hour or longer, and none had experienced significant trauma within the 24 hours prior to their enrollment in the study.

The lower the blood pressure nadir attained in the ED in this septic population, the greater the associated in-hospital mortality, noted Dr. Marchick of Carolinas Medical Center, Charlotte, N.C. (See box.)

In-hospital mortality occurred in 3.6% of 550 septic patients with no hypotension, 9.3% of 86 patients with a single transient hypotensive episode, and 10.9% of 64 patients with multiple episodes.

In a multivariate regression analysis that adjusted for acute organ dysfunction, comorbidities, and demographic variables, nonsustained hypotension emerged as the strongest risk factor for in-hospital mortality, conferring 2.7-fold increased risk, he said.

Source Elsevier Global Medical News