title: The significance of non-sustained hypotension in emergency department patients with sepsis.
abstract: OBJECTIVE
  Few studies have documented the incidence and significance of non-sustained hypotension in emergency department (ED) patients with sepsis. We hypothesized that ED non-sustained hypotension increases risk of in-hospital mortality in patients with sepsis.
  
  
  METHODS
  Secondary analysis of a prospective cohort study. ED patients aged > 17 years admitted to the hospital with explicitly defined sepsis were prospectively identified.
  
  
  METHODS
  Evidence of systemic inflammation (> 1 criteria) and suspicion for infection. Patients with overt shock were excluded. The primary outcome was in-hospital mortality.
  
  
  RESULTS
  Seven hundred patients with sepsis were enrolled, including 150 (21%) with non-sustained hypotension. The primary outcome of in-hospital mortality was present in 10% (15/150) of patients with non-sustained hypotension compared with 3.6% (20/550) of patients with no hypotension. The presence of non-sustained hypotension resulted in three times the risk of mortality than no hypotension (risk ratio = 2.8, 95% CI 1.5-5.2). Patients with a lowest systolic blood pressure < 80 mmHg had a threefold increase in mortality rate compared with patients with a lowest systolic blood pressure > or = 80 mmHg (5 vs. 16%). In logistic regression analysis, non-sustained hypotension was an independent predictor of in-hospital mortality.
  
  
  CONCLUSIONS
  Non-sustained hypotension in the ED confers a significantly increased risk of death during hospitalization in patients admitted with sepsis. These data should impart reluctance to dismiss non-sustained hypotension, including a single measurement, as not clinically significant or meaningful.
authors.affiliation: Emergency Medicine Research, Department of Emergency Medicine, Carolinas Medical Center, PO Box 32861, Charlotte, NC 28232-2861, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Marchick
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kline
authors.forename: Alan E
authors.initials: AE
authors.lastname: Jones
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D005544:Forecasting; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007022:Hypotension / Q000150:complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009657:North Carolina / Q000453:epidemiology; D016017:Odds Ratio; D011446:Prospective Studies; D018805:Sepsis / Q000401:mortality / Q000503:physiopathology*