Sean Coeckelenbergh1, Marc Van Nuffelen2, Christian Mélot3. 1. Anesthesia Department, Erasme University Hospital, Lennik street 808, B-1070 Brussels, Belgium. 2. Emergency Department, Erasme University Hospital, Lennik street 808, B-1070 Brussels, Belgium. 3. Emergency Department, Erasme University Hospital, Lennik street 808, B-1070 Brussels, Belgium. Electronic address: cmelot@ulb.ac.be.
Abstract
OBJECTIVE: Hypotension, defined as a mean arterial pressure of maximum 70 mmHg, is associated with significant morbidity and mortality. The objective of this study was to determine in initially non-critical hypotensive adult patients the proportion of sepsis and if septic patients had different outcome and clinical factors than non-septic patients. METHODS: This retrospective observational study was conducted over a year on adult hypotensive emergency department patients initially considered by triage as non-critical. Patients were separated into three groups: hypotensive septic patients (HSP), hypotensive non-septic infected patients (HNSIP), and other hypotensive patients (OHP). Clinical scores, signs, length of stay (LOS), and mortality were compared using analysis of variance for continuous variables and chi-square analysis for categorical variables. RESULTS: There were 136 (35.5%) septic patients, 37 (9.7%) with non-septic infection, and 210 (54.8%) with another cause of hypotension. Overall in-hospital mortality was 12.0% and total mortality was greater in HSP than in HNSIP (20.6% vs. 5.4%, p = 0.031) or OHP (20.6 vs. 7.6%, p < 0.001). LOS was greater for HSP when compared to HNSIP (median(IQR): 9(6-17) vs. 6(1-13), p = 0.004) and OHP (median(IQR): 9(6-17) vs. 3(1-8) days, p < 0.0001). CONCLUSION: Sepsis in a priori non-critical hypotensive adult patients, when compared with other causes of hypotension, is associated with significantly higher mortality and increased LOS. Patients that present to the emergency department and have a MAP of 70mmHg or less must be rigorously evaluated and have consistent follow-up.
OBJECTIVE:Hypotension, defined as a mean arterial pressure of maximum 70 mmHg, is associated with significant morbidity and mortality. The objective of this study was to determine in initially non-critical hypotensive adult patients the proportion of sepsis and if septic patients had different outcome and clinical factors than non-septic patients. METHODS: This retrospective observational study was conducted over a year on adult hypotensive emergency department patients initially considered by triage as non-critical. Patients were separated into three groups: hypotensive septicpatients (HSP), hypotensive non-septic infectedpatients (HNSIP), and other hypotensivepatients (OHP). Clinical scores, signs, length of stay (LOS), and mortality were compared using analysis of variance for continuous variables and chi-square analysis for categorical variables. RESULTS: There were 136 (35.5%) septic patients, 37 (9.7%) with non-septic infection, and 210 (54.8%) with another cause of hypotension. Overall in-hospital mortality was 12.0% and total mortality was greater in HSP than in HNSIP (20.6% vs. 5.4%, p = 0.031) or OHP (20.6 vs. 7.6%, p < 0.001). LOS was greater for HSP when compared to HNSIP (median(IQR): 9(6-17) vs. 6(1-13), p = 0.004) and OHP (median(IQR): 9(6-17) vs. 3(1-8) days, p < 0.0001). CONCLUSION:Sepsis in a priori non-critical hypotensive adult patients, when compared with other causes of hypotension, is associated with significantly higher mortality and increased LOS. Patients that present to the emergency department and have a MAP of 70mmHg or less must be rigorously evaluated and have consistent follow-up.
Authors: Josiane Fernandes Silva; Vania C Olivon; Fabiola Leslie A C Mestriner; Camila Ziliotto Zanotto; Raphael Gomes Ferreira; Nathanne Santos Ferreira; Carlos Alberto Aguiar Silva; João Paulo Mesquita Luiz; Juliano Vilela Alves; Rubens Fazan; Fernando Queiróz Cunha; Jose Carlos Alves-Filho; Rita C Tostes Journal: Front Physiol Date: 2020-01-21 Impact factor: 4.566
Authors: Valentino D'Onofrio; Agnes Meersman; Sara Vijgen; Reinoud Cartuyvels; Peter Messiaen; Inge C Gyssens Journal: Open Forum Infect Dis Date: 2020-12-28 Impact factor: 3.835