Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc
Journal website http://www.jocmr.org

Original Article

Volume 10, Number 7, July 2018, pages 576-581


Characteristics and Factors Associated With the Mortality of Hypotensive Patients Attending the Emergency Department

Tables

Table 1. Baseline Characteristics and Clinical Outcomes of 233 Hypotensive Patients
 
Characteristicsn (%)Characteristicsn (%)
*Data are expressed as mean ± SD. †Data are expressed as median (IQR). BMI: body mass index; EMS: emergency medical service; ED: emergency department; SBP: systolic blood pressure; DBP: diastolic blood pressure; MAP: mean arterial pressure. Shock index = heart rate/systolic blood pressure. Modified shock index = heart rate/MAP. SIRs: systemic inflammatory responses; qSOFA score: quick sequential organ failure assessment score; IV: intravenous.
Male gender125 (53.7%)SIRS criteria ≥ 285 (36.5%)
Age (year)*61.4 ± 20.2qSOFA score ≥ 251 (21.9%)
BMI (kg/m2)*22.2 ± 3.9Suspected cause of hypotension
Underlying diseases161 (69.1%)  Hypovolemic95 (40.8%)
  Diabetes mellitus61 (26.2%)  Infection113 (50.2%)
  Hypertension94 (40.3%)  Cardiovascular33 (14.2%)
  Other6 (3.7%)  Anaphylaxis7 (3.0%)
Patient status bed ridden46 (19.7%)  Neurogenic1 (0.4%)
Mode of transportation  Hemorrhagic23 (9.9%)
  EMS26 (11.2%)  Adrenal insufficiency7 (3.0%)
  Family207 (88.8%)Diagnosis of shock93 (39.9%)
Type of illnessSuspected type of shock
  Trauma10 (4.3%)  Hypovolemic21 (22.3%)
  Non-trauma223 (95.7%)  Cardiogenic15 (15.9%)
Chief complaint  Septic shock51 (54.3%)
  Fever43 (18.5%)  Anaphylactic shock7 (7.4%)
  Dyspnea39 (16.7%)Time to IV fluid administration (min)†29 (9 - 28)
  Abdominal pain20 (8.6%)Resuscitation time until MAP ≥ 65 mm Hg (min)†103 (30 - 120)
Triage level, critical5 (2.2%)ED admission time (h)†21 (6 - 25)
Vital signsInitial serum lactate concentration (mmol/L)†3.5 (1.6 - 4.4)
  Pulse rate (/min)*96 ± 26Management
  SBP (mm Hg)*78 ± 8  Intubation39 (16.7%)
  DBP (mm Hg)*48 ± 8  Total fluid in first hour (mL)†758 (500 - 1,000)
  MAP (mm Hg)*58 ± 7  Total fluid until MAP ≥ 65 mm Hg (mL)†1,142 (500 - 1,500)
  Respiratory rate (/min)*23 ± 5  Vasopressor administration63 (27.0%)
  Pulse oximetry ≤ 90%17 (7.3%)Recurrent hypotension94 (40.3%)
  Body temperature > 38.3 °C38 (16.3%)Mortality outcome
Altered mental status51 (21.9%)  Death in ED9 (3.9%)
Shock index*1.3 ± 0.4  Death within 24 h10 (4.3%)
Modified shock index*1.7 ± 0.5  Death within 48 h19 (8.2%)

 

Table 2. Univariable Analysis of Factors Associated With 48 h Mortality in Hypotensive Patients
 
CharacteristicsOdds ratio95% CIP value
EMS: emergency medical service; MAP: mean arterial pressure; CI: confidence interval; ED: emergency department; SBP: systolic blood pressure; IV: intravenous. Shock index = heart rate/systolic blood pressure. Modified shock index = heart rate/MAP. qSOFA score: quick sequential organ failure assessment score; WBC: white blood cell count.
Male gender1.530.58 - 4.040.389
Age ≥ 65 years1.110.43 - 2.840.826
Underlying disease1.280.44 - 3.680.652
Patient status bed ridden3.371.27 - 8.940.015
Body temperature > 38.3 °C3.760.49 - 29.070.204
Initial pulse rate > 100 beats/min5.581.79 - 17.390.003
Initial pulse oximetry ≤ 90%8.332.84 - 24.49< 0.001
Altered mental status7.692.84 - 20.80< 0.001
Shock index > 0.94.530.59 - 34.850.147
Modified shock index > 1.35.770.75 - 44.330.092
qSOFA score ≥ 27.692.84 - 20.79< 0.001
Traumatic patient1.270.15 - 10.560.828
Diagnosis of shock33.364.37 - 254.800.001
Time to initial IV fluid < 30 min1.500.42 - 5.370.532
Time to target BP (MAP ≥ 65) < 60 min1.160.40 - 2.640.965
Total fluid in first hour ≥ 1,500 mL4.741.50 - 14.940.008
Vasopressor administration2.661.03 - 6.910.043
Intubation7.092.66 - 18.92< 0.001
Recurrent hypotension9.302.63 - 32.920.001
WBC (/µL) > 12,000 or < 4,0001.650.63 - 4.360.311
Serum lactate concentration ≥ 4 mmol/L1.860.68 - 5.090.224
ED admission time > 8 h1.090.41 - 2.870.868

 

Table 3. Multivariable Analysis of Factors Associated With 48 h Mortality in Hypotensive Patients
 
CharacteristicsOdds ratio95% CIP value
CI: confidence interval; qSOFA score: quick sequential organ failure assessment score.
Patient status bed ridden2.240.63 - 8.000.214
Initial pulse rate > 100 beats/min4.211.05 - 16.880.042
Initial pulse oximetry ≤ 90%2.940.68 - 12.740.149
qSOFA score ≥ 23.130.94 - 10.300.061
Altered mental status2.200.60 - 8.040.235
Diagnosis of shock13.741.49 - 126.610.021
Intubation1.880.52 - 6.820.337
Total fluid in first hour ≥ 1,500 mL3.790.72 - 20.000.117
Vasopressor administration0.530.15 - 1.860.322
Recurrent hypotension6.911.54 - 30.990.012