J Clin Med Res

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

**Table 1.** Baseline Characteristics and Clinical Outcomes of 233 Hypotensive Patients
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%)

Table 1. Baseline Characteristics and Clinical Outcomes of 233 Hypotensive Patients

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%)

**Table 2.** Univariable Analysis of Factors Associated With 48 h Mortality in Hypotensive Patients
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

Table 2. Univariable Analysis of Factors Associated With 48 h Mortality in Hypotensive Patients

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

**Table 3.** Multivariable Analysis of Factors Associated With 48 h Mortality in Hypotensive Patients
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

Table 3. Multivariable Analysis of Factors Associated With 48 h Mortality in Hypotensive Patients

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