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
Characteristics | n (%) | Characteristics | n (%) |
---|---|---|---|
*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 gender | 125 (53.7%) | SIRS criteria ≥ 2 | 85 (36.5%) |
Age (year)* | 61.4 ± 20.2 | qSOFA score ≥ 2 | 51 (21.9%) |
BMI (kg/m2)* | 22.2 ± 3.9 | Suspected cause of hypotension | |
Underlying diseases | 161 (69.1%) | Hypovolemic | 95 (40.8%) |
Diabetes mellitus | 61 (26.2%) | Infection | 113 (50.2%) |
Hypertension | 94 (40.3%) | Cardiovascular | 33 (14.2%) |
Other | 6 (3.7%) | Anaphylaxis | 7 (3.0%) |
Patient status bed ridden | 46 (19.7%) | Neurogenic | 1 (0.4%) |
Mode of transportation | Hemorrhagic | 23 (9.9%) | |
EMS | 26 (11.2%) | Adrenal insufficiency | 7 (3.0%) |
Family | 207 (88.8%) | Diagnosis of shock | 93 (39.9%) |
Type of illness | Suspected type of shock | ||
Trauma | 10 (4.3%) | Hypovolemic | 21 (22.3%) |
Non-trauma | 223 (95.7%) | Cardiogenic | 15 (15.9%) |
Chief complaint | Septic shock | 51 (54.3%) | |
Fever | 43 (18.5%) | Anaphylactic shock | 7 (7.4%) |
Dyspnea | 39 (16.7%) | Time to IV fluid administration (min)† | 29 (9 - 28) |
Abdominal pain | 20 (8.6%) | Resuscitation time until MAP ≥ 65 mm Hg (min)† | 103 (30 - 120) |
Triage level, critical | 5 (2.2%) | ED admission time (h)† | 21 (6 - 25) |
Vital signs | Initial serum lactate concentration (mmol/L)† | 3.5 (1.6 - 4.4) | |
Pulse rate (/min)* | 96 ± 26 | Management | |
SBP (mm Hg)* | 78 ± 8 | Intubation | 39 (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 administration | 63 (27.0%) |
Pulse oximetry ≤ 90% | 17 (7.3%) | Recurrent hypotension | 94 (40.3%) |
Body temperature > 38.3 °C | 38 (16.3%) | Mortality outcome | |
Altered mental status | 51 (21.9%) | Death in ED | 9 (3.9%) |
Shock index* | 1.3 ± 0.4 | Death within 24 h | 10 (4.3%) |
Modified shock index* | 1.7 ± 0.5 | Death within 48 h | 19 (8.2%) |
Characteristics | Odds ratio | 95% CI | P 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 gender | 1.53 | 0.58 - 4.04 | 0.389 |
Age ≥ 65 years | 1.11 | 0.43 - 2.84 | 0.826 |
Underlying disease | 1.28 | 0.44 - 3.68 | 0.652 |
Patient status bed ridden | 3.37 | 1.27 - 8.94 | 0.015 |
Body temperature > 38.3 °C | 3.76 | 0.49 - 29.07 | 0.204 |
Initial pulse rate > 100 beats/min | 5.58 | 1.79 - 17.39 | 0.003 |
Initial pulse oximetry ≤ 90% | 8.33 | 2.84 - 24.49 | < 0.001 |
Altered mental status | 7.69 | 2.84 - 20.80 | < 0.001 |
Shock index > 0.9 | 4.53 | 0.59 - 34.85 | 0.147 |
Modified shock index > 1.3 | 5.77 | 0.75 - 44.33 | 0.092 |
qSOFA score ≥ 2 | 7.69 | 2.84 - 20.79 | < 0.001 |
Traumatic patient | 1.27 | 0.15 - 10.56 | 0.828 |
Diagnosis of shock | 33.36 | 4.37 - 254.80 | 0.001 |
Time to initial IV fluid < 30 min | 1.50 | 0.42 - 5.37 | 0.532 |
Time to target BP (MAP ≥ 65) < 60 min | 1.16 | 0.40 - 2.64 | 0.965 |
Total fluid in first hour ≥ 1,500 mL | 4.74 | 1.50 - 14.94 | 0.008 |
Vasopressor administration | 2.66 | 1.03 - 6.91 | 0.043 |
Intubation | 7.09 | 2.66 - 18.92 | < 0.001 |
Recurrent hypotension | 9.30 | 2.63 - 32.92 | 0.001 |
WBC (/µL) > 12,000 or < 4,000 | 1.65 | 0.63 - 4.36 | 0.311 |
Serum lactate concentration ≥ 4 mmol/L | 1.86 | 0.68 - 5.09 | 0.224 |
ED admission time > 8 h | 1.09 | 0.41 - 2.87 | 0.868 |
Characteristics | Odds ratio | 95% CI | P value |
---|---|---|---|
CI: confidence interval; qSOFA score: quick sequential organ failure assessment score. | |||
Patient status bed ridden | 2.24 | 0.63 - 8.00 | 0.214 |
Initial pulse rate > 100 beats/min | 4.21 | 1.05 - 16.88 | 0.042 |
Initial pulse oximetry ≤ 90% | 2.94 | 0.68 - 12.74 | 0.149 |
qSOFA score ≥ 2 | 3.13 | 0.94 - 10.30 | 0.061 |
Altered mental status | 2.20 | 0.60 - 8.04 | 0.235 |
Diagnosis of shock | 13.74 | 1.49 - 126.61 | 0.021 |
Intubation | 1.88 | 0.52 - 6.82 | 0.337 |
Total fluid in first hour ≥ 1,500 mL | 3.79 | 0.72 - 20.00 | 0.117 |
Vasopressor administration | 0.53 | 0.15 - 1.86 | 0.322 |
Recurrent hypotension | 6.91 | 1.54 - 30.99 | 0.012 |