title: Arterial blood pressure during early sepsis and outcome.
abstract: OBJECTIVE
  To evaluate the association between arterial blood pressure (ABP) during the first 24 h and mortality in sepsis.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Multidisciplinary intensive care unit (ICU).
  
  
  METHODS
  A total of 274 septic patients.
  
  
  METHODS
  None.
  
  
  RESULTS
  Hemodynamic, and laboratory parameters were extracted from a PDMS database. The hourly time integral of ABP drops below clinically relevant systolic arterial pressure (SAP), mean arterial pressure (MAP), and mean perfusion pressure (MPP = MAP - central venous pressure) levels was calculated for the first 24 h after ICU admission and compared with 28-day-mortality. Binary and linear regression models (adjusted for SAPS II as a measure of disease severity), and a receiver operating characteristic (ROC) analysis were applied. The areas under the ROC curve were largest for the hourly time integrals of ABP drops below MAP 60 mmHg (0.779 vs. 0.764 for ABP drops below MAP 55 mmHg; P < or = 0.01) and MPP 45 mmHg. No association between the hourly time integrals of ABP drops below certain SAP levels and mortality was detected. One or more episodes of MAP < 60 mmHg increased the risk of death by 2.96 (CI 95%, 1.06-10.36, P = 0.04). The area under the ROC curve to predict the need for renal replacement therapy was highest for the hourly time integral of ABP drops below MAP 75 mmHg.
  
  
  CONCLUSIONS
  A MAP level > or = 60 mmHg may be as safe as higher MAP levels during the first 24 h of ICU therapy in septic patients. A higher MAP may be required to maintain kidney function.
authors.affiliation: Department of Intensive Care Medicine, Inselspital, 3010, Bern, Switzerland. Martin.Duenser@i-med.ac.at
authors.forename: Martin W
authors.initials: MW
authors.lastname: Dünser
authors.forename: Jukka
authors.initials: J
authors.lastname: Takala
authors.forename: Hanno
authors.initials: H
authors.lastname: Ulmer
authors.forename: Viktoria D
authors.initials: VD
authors.lastname: Mayr
authors.forename: Günter
authors.initials: G
authors.lastname: Luckner
authors.forename: Stefan
authors.initials: S
authors.lastname: Jochberger
authors.forename: Fritz
authors.initials: F
authors.lastname: Daudel
authors.forename: Philipp
authors.initials: P
authors.lastname: Lepper
authors.forename: Walter R
authors.initials: WR
authors.lastname: Hasibeder
authors.forename: Stephan M
authors.initials: SM
authors.lastname: Jakob
mesh_terms: D000368:Aged; D001158:Arteries; D001794:Blood Pressure / Q000502:physiology*; D015331:Cohort Studies; D003422:Critical Care; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000453:epidemiology; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D018805:Sepsis / Q000503:physiopathology*