Lower Admission Systolic Blood Pressure Research Articles

Ultra‐Early Functional Improvement After Stroke Thrombectomy – Predictors and Implications

Background Neurocritical care is routinely provided to patients post‐endovascular thrombectomy (EVT) for anterior large vessel occlusion strokes. We aim to study the relationship between immediate improvement in National Institutes of Health Stroke Scale (NIHSS) score on outcomes post‐EVT and potential implications for postprocedural care. Methods We performed a retrospective review of anterior circulation large vessel occlusion (internal carotid/proximal middle cerebral artery) patients undergoing EVT. Demographic, clinical, and imaging information was analyzed. Ultra‐early functional improvement (UEFI) was defined as NIHSS score <6 within 30 minutes of successful recanalization. We analyzed the incidence and predictors of UEFI, and explored reasons for neurological decline post‐UEFI. Results Of the 343 anterior large vessel occlusion patients undergoing EVT, mean age was 71 ± 15 and 46% were male. Mean NIHSS was 17 ± 6 and Time Last Known Well (TLKW) to arrival was 9 ± 11 hours. UEFI was observed in 23% (79/343) of patients. Independent predictors of UEFI included lower pretreatment NIHSS, favorable Alberta Stroke Program Early CT Score (ASPECTS), and lower admission systolic blood pressure. Rates of 90‐day‐modified Rankin scale 0–2 were higher (71% versus 33%, P <0.01) and the rate of mortality (8% versus 28%, P <0.01) was lower in the UEFI group compared with the non‐UEFI group. Amongst patients with UEFI, 1.3% (1/79) experienced increase in NIHSS by ≥4 points within 24 hours of EVT. This patient received thrombolysis, achieved TICI‐2B recanalization, and follow‐up neuroimaging revealed a parenchymal hemorrhage and an infarct volume of 44 mL. None of the patients with UEFI required continuous antihypertensive infusions. Conclusions Approximately 1‐in‐4 of anterior large vessel occlusion stroke patients undergoing EVT have an NIHSS score of <6 within 30 minutes of successful recanalization. Only 1% of them experience significant decline in neurological status within 24 hours of the procedure with the majority achieving functional independence at 90 days. The need for advanced neurocritical care should be reevaluated in these patients.

MRI-guided thrombolysis for lenticulostriate artery stroke within 12h of symptom onset.

Stroke thrombolysis treatment is generally administered within 4.5 h, but a greater time window may be permitted depending upon the ischemic penumbra on neuroimaging. This observational cohort study investigated the outcomes of thrombolysis given within 12 h after symptom onset of lenticulostriate artery stroke. The population comprised 160 patients. Thrombolysis was administered via tissue plasminogen activator, alteplase (TPA). Thrombolysis was indicated by a mismatch between diffusion-weighted imaging (DWI) and T2-weighted imaging (T2WI), that is, an acute ischemic lesion on DWI without a corresponding lesion on T2WI. Demographics and medical history were compared with the modified Rankin scale (mRS) score, to reflect outcome. Patients with a favorable clinical outcome (mRS 0–1) had significantly lower hypertension, baseline NIH Stroke Scale (NIHSS) score, and admission systolic/diastolic blood pressure compared with patients with mRS 2–6. Lower admission systolic blood pressure and NIHSS score were significantly associated with favorable outcome. In patients either with IV-TPA within 4.5 h, or between 4.5 and 12 h, lower admission systolic blood pressure and/or NIHSS score similarly independently predict favorable outcome. However, in all groups, the onset-to-treatment time did not significantly influence the outcomes. We conclude that in our cohort higher admission systolic blood pressure and higher baseline NIHSS and not time were associated with poor outcome in patients with magnetic resonance-guided thrombolysis within 12 h of isolated lenticulostriate artery stroke, therefore loosening the traditionally perceived dependency of outcome on time.

31 ADMISSION OF SYSTOLIC BLOOD PRESSURE AND ANTECEDENT HYPERTENSION WORSENING THE SHORT-TERM OUTCOMES AFTER ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION

Background and Aim: The prevalence of antecedent hypertension varies from 46.0% to 63.4%. Until recently, many studies evaluated the prognostic significance of a previous history of hypertension in patients presented with ST-segment elevation myocardial infarction (STEMI) and came to inconsistent result. We evaluated the combined effect of admission systolic blood pressure (SBP) and antecedent hypertension on short-term outcomes in patients with STEMI. Materials and Methods: Data were derived from Malang ACS registry of 534 consecutive patients with STEMI. STEMI within 12 hours after the onset of symptoms 2018 and 2020. The diagnosis of STEMI was followed the universal definition of myocardial infarction. Patients were divided into 4 groups according to different blood pressure status: high SBP without hypertension, high SBP with hypertension, low SBP without hypertension, and low SBP with hypertension. The primary endpoints were 30-day all-cause mortality. Results: The prevalence of hypertension was 38.6%, and the best cutoff of admission SBP for predicting 30-day mortality was 94 mmHg by receiver-operating characteristic curve. Patients with hypertension were older, more often male, also had longer onset-to-admission time, more comorbidities, and higher Killip class. Patients with both low SBP (±94 mmHg) and hypertension group had significantly higher 30-day mortality than those in other groups (all P < 0.000). After multivariate adjustment, low SBP with hypertension group was still an independent risk factor for predicting 30-day mortality (hazard ratios [HR] 1.66, 95% confidence interval [CI] 1.21—2.16; P < 0.001). In patients with SBP > 94 mmHg, a history of hypertension could increase the risk of 30-day mortality by 17% (HR 1.06 vs 1.37, P = 0.004), while in patients with SBP ± 94 mmHg, this increased risk reached to 44% (HR 1.21 vs 2.38, P < 0.001). Conclusion: Low admission SBP was the relatively dominant contributor for predicting 30-day all-cause mortality, and a concurrent antecedent hypertension increased the corresponding risk of mortality

Time Metrics in Acute Ischemic Stroke Care During the Second and First Wave of COVID 19 Pandemic: A Tertiary Care Center Experience from South India

BackgroundDuring the first wave of the pandemic, stroke care suffered globally and there were reduced stroke admissions and delays in time metrics. Stroke care was reorganized during the second wave learning from the experience of previous wave. This study shares our experience in stroke time metrics during the second wave of pandemic compared to the first wave. MethodsWe did a single-center prospective study, where consecutive acute ischemic stroke patients within 24 hours of the onset of symptoms and aged more than 18 years, who presented to Stroke Unit, Department of Neurology, Government Medical College, Thiruvananthapuram from June 1st to 31st August, 2020 and June 1st to 31st August in 2021 were included. In-hospital time metrics (door to CT time and door to Needle time) were compared during the two time periods. We also compared functional outcomes at discharge and in-hospital mortality during the two periods. Functional outcome at discharge was assessed by modified Rankin scale (mRS). ResultsFrom June to August 2021 (second wave of the COVID 19 pandemic), compared to the same months during the first wave (2020), our study demonstrated better in-hospital time metrics (door to CT time and door to needle time). We also found lower admission systolic blood pressure and higher baseline CT early ischemic changes during the second wave. There was no difference in functional outcome at discharge and in-hospital mortality. Intravenous thrombolysis rates also remained the same during the two periods. ConclusionOur study has confirmed that time metrics in stroke care can be improved through system rearrangement even during the pandemic. Acute stroke treatments are time-dependent and hospital administrators must stick to the maxim “Time is Brain” while restructuring stroke workflows during future challenges.

Prognostic value of brain natriuretic peptide in ST-elevation myocardial infarction patients: A Portuguese registry

IntroductionBrain natriuretic peptide (BNP) is a highly sensitive and specific biomarker for the extent of myocardial infarction that is strongly related to short- and long-term prognosis in patients with acute coronary syndromes. ObjectiveTo assess the prognostic value of BNP levels in a Portuguese cohort of ST-elevation myocardial infarction (STEMI) patients. MethodsWe performed a retrospective analysis of patients admitted with STEMI included in the Portuguese Registry of Acute Coronary Syndromes (ProACS) between 2010 and 2019. Patients were divided into three groups according to BNP level (<100 pg/ml, 100-399 pg/ml and ≥400 pg/ml) and compared. Independent predictors of a composite of all-cause mortality and rehospitalization for cardiovascular causes were assessed by multivariate logistic regression. For sample homogenization, propensity score matching and pairwise matching with a tolerance level of 0.005 were performed. ResultsA total of 1650 patients were included, of whom 21.5% presented high BNP levels (≥400 pg/ml). These were older and had more comorbidities, lower admission systolic blood pressure and hemoglobin, higher heart rate, Killip class and creatinine, worse left ventricular systolic function and severe coronary anatomy. Higher BNP was associated with more in-hospital complications, in-hospital mortality and adverse outcomes at one year. ConclusionBNP levels during the index hospitalization were a powerful prognostic biomarker for all-cause mortality and major adverse cardiac events in patients admitted with STEMI to Portuguese hospitals.

OR37. Factors associated with in-hospital mortality in patients hospitalized with acute coronary syndrome

Abstract Background and Aims Acute coronary syndrome (ACS) remains a source of high mortality worldwide, therefore it is important to determine factors associated with worse outcomes to better develop strategies to reduce the burden of disease. This paper aims to describe the characteristics of patients admitted with ACS to Kediri General Hospital and factors associated with in-hospital mortality. Methods and Result In this study, 117 patients admitted with ACS to Kediri General Hospital between January and June 2020 were included. Data were collected retrospectively from medical records and analysed using SPSS software v25. The median age was 60 (36-93) years old, 64 (54,7%) were male. They were presented either with STE-ACS (41%) or NSTE-ACS (59%). During hospitalization, 18 (15,4%) died. The bivariate analysis showed the patients who died were predominantly female (22,6% vs 9,4%, p = 0.048); had higher prevalence of Killip IV (38,9%, p = 0,003); higher prevalence of clinical signs of heart failure (23,7% vs 6,9%, p = 0,012); lower admission systolic blood pressure (117 ± 26,0 vs 137 ± 37,0, p = 0,036); lower admission diastolic blood pressure (70,6 ± 20,6 vs 81,5 ± 20,5, p = 0,04); and higher heart rate (104 ± 24 vs 91 ± 22, p = 0,026). From multivariable analysis, variables significantly associated with in-hospital mortality were decreased consciousness (OR 11, 95% CI 1.327-92.4, p = 0.026) and Killip class IV (OR 9.558, 95% CI 2.016-45.317). Conclusion Decreased consciousness and Killip class IV were significant independent predictors of in-hospital mortality in ACS.

Systolic blood pressure at admission and long-term clinical outcomes in patients hospitalized for heart failure.

AimsThe study sought to investigate the association between admission systolic blood pressure (SBP) and 1‐year clinical outcomes in patients hospitalized for heart failure (HF) and in subgroups.MethodsThis study was based on the China Patient‐centred Evaluative Assessment of Cardiac Events Prospective Heart Failure Study, which prospectively enrolled patients hospitalized for HF in 52 hospitals from 20 provinces in China between August 2016 and May 2018. Patients were divided into four groups according to the quartiles of SBP at admission. The multivariable Cox proportional hazards regression models were fitted to examine the association between admission SBP and all‐cause death and HF readmission within 1 year after the index hospitalization. Restricted cubic splines were used to explore the non‐linear association between SBP and the clinical outcomes.ResultsAmong 4896 patients, those with lower admission SBP were younger, more likely to be male, have left ventricular ejection fraction <40%, and receive β‐blockers, aldosterone antagonists, and diuretics. After adjustment for potential confounders, lower admission SBP was significantly associated with higher all‐cause death and there is no threshold, while we only observed such an association with HF readmission when admission SBP was lower than 120 mmHg. Compared with the 4th SBP quartile, patients in the 1st SBP quartile had higher risk of all‐cause death (hazard ratio, 1.85; 95% confidence interval 1.48–2.33; P < 0.001) and HF readmission (hazard ratio, 1.40; 95% confidence interval 1.19–1.65, P < 0.001). These associations were consistent in most subgroups, such as age, sex, and left ventricular ejection fraction.ConclusionsIn patients hospitalized for HF, lower admission SBP portends an increased risk of 1 year all‐cause death and HF readmission, and these associations were consistent among subgroups.

Admission systolic blood pressure as a prognostic predictor of acute decompensated heart failure: A report from the KCHF registry.

Admission systolic blood pressure has emerged as a predictor of postdischarge outcomes of patients with acute decompensated heart failure; however, its validity in varied clinical conditions of this patient subset is unclear. The aim of this study was to further explore the prognostic value of admission systolic blood pressure in patients with acute decompensated heart failure. The Kyoto Congestive Heart Failure (KCHF) registry is a prospective, observational, multicenter cohort study enrolling consecutive patients with acute decompensated heart failure from 19 participating hospitals in Japan. Clinical characteristics at baseline and prognosis were examined by the following value range of admission systolic blood pressure: <100, 100-139, and ≥140 mmHg. The primary outcome measure was defined as all-cause death after discharge. Subgroup analyses were done for prior hospitalization for heart failure, hypertension, left ventricular ejection fraction, and medications at discharge. We excluded patients with acute coronary syndrome or insufficient data. We analyzed 3564 patients discharged alive out of 3804 patients hospitalized for acute decompensated heart failure. In the entire cohort, lower admission systolic blood pressure was associated with poor outcomes (1-year cumulative incidence of all-cause death: <100 mmHg, 26.8%; 100-139 mmHg, 20.2%; and ≥140 mmHg, 15.1%, p<0.001). The magnitude of the effect of lower admission systolic blood pressure for postdischarge all-cause death was greater in patients with prior hospitalization for heart failure, heart failure with reduced left ventricular ejection fraction, and β-blocker use at discharge than in those without. Admission systolic blood pressure is useful for postdischarge risk stratification in patients with acute decompensated heart failure. Its magnitude of the effect as a prognostic predictor may differ across clinical conditions of patients.

Association Between Ionized Calcium Concentrations During Hemostatic Transfusion and Calcium Treatment With Mortality in Major Trauma.

Transfusion of citrated blood products may worsen resuscitation-induced hypocalcemia and trauma outcomes, suggesting the need for protocolized early calcium replacement in major trauma. However, the dynamics of ionized calcium during hemostatic resuscitation of severe injury are not well studied. We determined the frequency of hypocalcemia and quantified the association between the first measured ionized calcium concentration [iCa] and calcium administration early during hemostatic resuscitation and in-hospital mortality. We performed a retrospective cohort study of all admissions to our regional level 1 trauma center who (1) were ≥15 years old; (2) presented from scene of injury; (3) were admitted between October 2016 and September 2018; and (4) had a Massive Transfusion Protocol activation. They also (1) received blood products during transport or during the first 3 hours of in-hospital care (1st3h) of trauma center care and (2) had at least one [iCa] recorded in that time. Demographic, injury severity, admission shock and laboratory data, blood product use and timing, and in-hospital mortality were extracted from Trauma Registry and Transfusion Service databases and electronic medical records. Citrate load was calculated on a unit-by-unit basis and used to calculate an administered calcium/citrate molar ratio. Univariate and multivariable logistic regression analyses for the binary outcome of in-hospital death were performed. A total of 11,474 trauma patients were admitted to the emergency department over the study period, of whom 346 (3%; average age: 44 ± 18 years; 75% men) met all study criteria. In total, 288 (83.2%) had hypocalcemia at first [iCa] determination; 296 (85.6%) had hypocalcemia in the last determination in the 1st3h; and 177 (51.2%) received at least 1 calcium replacement dose during that time. Crude risk factors for in-hospital death included age, injury severity score (ISS), new ISS (NISS), Abbreviated Injury Scale (AIS) head, admission systolic blood pressure (SBP), pH, and lactate; all P < .001. Higher in-hospital mortality was significantly associated with older age, higher NISS, AIS head, and admission lactate, and lower admission SBP and pH. There was no relationship between mortality and first [iCa] or calcium dose corrected for citrate load. In our study, though most patients had hypocalcemia during the 1st3h of trauma center care, neither first [iCa] nor administered calcium dose corrected for citrate load were significantly associated with in-patient mortality. Clinically, hypocalcemia during early hemostatic resuscitation after severe injury is important, but specific treatment protocols must await better understanding of calcium physiology in acute injury.

Abstract 12789: Clinical Factors Associated With Mortality Among Patients Hospitalized for Heart Failure in Egypt

Introduction: Heart failure (HF) is a growing public health burden in many low and middle-income countries (LMIC). However, most HF registries were conducted in high income countries, which often have different ethnic and cultural backgrounds from that of LMIC. Hypothesis: Independent clinical variables associated with mortality in patients hospitalized for HF in Egypt are different from those established in the United States (US). Methods: Between 2011 and 2014, 1,660 patients hospitalized for HF were enrolled from 20 centers across Egypt as part of the European Society of Cardiology HF long-term Registry. Deceased patients were compared to survivors, to identify demographic, clinical and biochemical variables associated with in-hospital and one-year mortality. Variables associated with mortality on univariate analysis, and independent variables identified in the Acute Decompensated Heart Failure National Registry (ADHERE) and in the Seattle Heart Failure Model, both based in the US, were entered into the multivariate logistic regression model. Results: In-hospital mortality was 5%. Only two independent clinical factors associated with in-hospital mortality were identified: elevated serum creatinine (sCr), OR=1.47 [95% CI: 1.23, 1.74] for every point increases above one mg/dl; and low admission systolic blood pressure (SBP), OR=1.54; [95% CI: 1.43, 1.65] for every 10 points decrease in SBP below 140 mmHg. At one-year follow up, mortality was 27%. Independent predictors of one-year mortality were: age, OR=1.47; [95% CI: 1.23,1.75] for every 10-year increase above 40; low discharge SBP, OR=1.30 [95% CI: 1.08, 1.52] for every 10 points decrease below 140 mmHg; low ejection fraction, OR=1.51 [95% CI: 0.59,0.73] for every 5 points decrease from 65%; chronic liver disease, OR=3.0 [95% CI: 1.51,5.88]; history of stroke, OR=3.2 [95% CI: 1.52,6.65]. These variables overlapped with those identified in US registries. Conclusions: Independent clinical variables associated with mortality after HF hospitalization in Egypt are similar to those reported in HF registries in the US.

Management of duodenal trauma: A retrospective review from the Panamerican Trauma Society.

The operative management of duodenal trauma remains controversial. Our hypothesis is that a simplified operative approach could lead to better outcomes. We conducted an international multicenter study, involving 13 centers. We performed a retrospective review from January 2007 to December of 2016. Data on demographics, mechanism of trauma, blood loss, operative time, and associated injured organs were collected. Outcomes included postoperative intra-abdominal sepsis, leak, need for unplanned surgery, length of stay, renal failure, and mortality. We used the Research Electronic Data Capture tool to store the data. Poisson regression using a backward selection method was used to identify independent predictors of mortality. We collected data of 372 patients with duodenal injuries. Although the duodenal trauma was complex (median Injury Severity Score [ISS], 18 [interquartile range, 2-3]; Abbreviated Injury Scale, 3.5 [3-4]; American Association for the Surgery of Trauma grade, 3 [2-3]), primary repair alone was the most common type of operative management (80%, n = 299). Overall mortality was 24%. On univariate analysis, mortality was associated with male gender, lower admission systolic blood pressure, need for transfusion before operative repair, higher intraoperative blood loss, longer operative time, renal failure requiring renal replacement therapy, higher ISS, and associated pancreatic injury. Poisson regression showed higher ISS, associated pancreatic injury, postoperative renal failure requiring renal replacement therapy, the need for preoperative transfusion, and male gender remained significant predictors of mortality. Duodenal suture line leak was statistically significantly lower, and patients had primary repair over every American Association for the Surgery of Trauma grade of injury. The need for transfusion prior to the operating room, associated pancreatic injuries, and postoperative renal failure are predictors of mortality for patients with duodenal injuries. Primary repair alone is a common and safe operative repair even for complex injuries when feasible. Therapeutic study, level IV.

Hematoma Expansion Differences in Lobar and Deep Primary Intracerebral Hemorrhage.

Hematoma expansion (HE) after intracerebral hemorrhage (ICH) is associated with worse outcome. Lobar ICHs are known to have better outcomes compared to deep ICH; however, it is unclear whether there are HE differences between these locations. We sought to investigate the hypothesis that lobar ICH has less HE compared to deep ICH. Primary ICH patients admitted between 2009 and 2016 were included in a prospective single-center ICH cohort study. Patients with preceding anticoagulant use, coagulopathy on admission labs, or presenting after 24 h from symptom onset were excluded. Lobar and deep ICH patients with baseline and follow-up computed tomography (CT) (within 24 h of admission CT) were evaluated. HE was defined primarily as relative growth > 33% given expected baseline hematoma volume differences between locations. Other commonly utilized definitions of HE: > 6mL, and > 33% or > 6mL, were additionally assessed. Multivariable logistic regression was used to assess the association of ICH location with HE while adjusting for previously identified covariates of HE. There were 59 lobar and 143 deep ICH patients analyzed. Lobar ICH patients had significantly larger baseline hematoma volumes, lower admission systolic blood pressure, and longer times to admission CT compared to deep ICH. Multivariable logistic regression revealed an association of lobar ICH with lower odds of HE (> 33%) [odds ratio (OR) 0.32; 95% confidence interval (CI) 0.11-0.93; p = 0.04] compared to deep ICH after adjusting for baseline ICH volume, blood pressure, and time to CT. Secondary analysis did not identify an association of lobar ICH with HE defined as > 6mL (adjusted OR 1.44; 95% CI 0.59-3.50; p = 0.41) or > 33% or > 6mL (adjusted OR 0.71; 95% CI 0.29-1.70; p = 0.44). We identified less HE in lobar compared to deep ICH. The use of absolute growth thresholds in defining HE may be limited when assessing groups with largely different baseline hematoma sizes. Further study is required to replicate our findings and investigate mechanisms for HE differences between lobar and deep ICH locations.

Relation of Admission Blood Pressure to In-hospital and 90-Day Outcomes in Patients Presenting With Transient Ischemic Attack

The association between admission blood pressure (BP) and outcomes in patients with transient ischemic attack (TIA) is not well defined. Patients in the United States national Get With The Guidelines-Stroke registry with a TIA were included. Admission systolic and diastolic BP was used to compute mean arterial pressure and pulse pressure (PP). A subset of this cohort was linked to Centers for Medicare and Medicaid claims data for postdischarge outcomes. The in-hospital outcomes of interest were: mortality, not discharged home, and inability to ambulate independently at discharge. Postdischarge, 30-day and 90-day outcomes of interest were mortality, readmission for stroke, and readmission for major cardiovascular event-composite of death, cerebrovascular, or cardiovascular readmission. Among the 218,803 patients with TIA, lower admission systolic blood pressure (SBP) was associated with worse in-hospital outcomes. Compared with patients with SBP of 150 mm Hg, a lower SBP of 120 mm Hg was associated with higher risk of in-hospital death (adjusted OR = 1.79; 95% CI = 1.50 to 2.12), not being discharged home (adjusted OR = 1.31; 95% CI = 1.27 to 1.36), or inability to ambulate independently at discharge (adjusted OR = 1.27; 95% CI = 1.23 to 1.31). Similarly, among the 64,352 patients in the Centers for Medicare and Medicaid-linked cohort, an inverse association between systolic BP and postdischarge mortality (p <0.0001), and major cardiovascular event (p = 0.0001) was observed at 30-days and at 90-days postdischarge. However, there was no relation between SBP and readmission for stroke either at 30-days (p = 0.35) or at 90-days (p = 0.11). Results were largely similar for diastolic BP, mean arterial pressure, PP, and outcomes. In conclusion, in patients with a transient ischemic attack, a BP paradox was observed, with higher admission BP associated with improved in-hospital, 30-day, and 90-day postdischarge outcomes.

Limit Crystalloid Resuscitation after Traumatic Brain Injury

Patients with traumatic brain injury (TBI) are often resuscitated with crystalloids in the emergency department (ED) to maintain cerebral perfusion. The purpose of this study was to evaluate whether crystalloid resuscitation volume impacts mortality in TBI patients. This was a retrospective study of trauma patients with head abbreviated injury scale score ≥2, who received crystalloids during ED resuscitation between 2004 and 2013. Clinical characteristics and volume of crystalloids received in the ED were collected. Patients who received <2 L of crystalloids were categorized as low volume (LOW), whereas those who received ≥2 L were considered high volume (HIGH). Mortality and outcomes were compared. Multivariable regression analysis was used to determine the odds of mortality while controlling for confounders. Over 10 years, 875 patients met inclusion criteria. Overall mortality was 12.5 per cent. Seven hundred and forty-two (85%) were in the LOW cohort and 133 (15%) in the HIGH cohort. Gender and age were similar between the groups. The HIGH cohort had lower admission systolic blood pressure (128 vs 138 mm Hg, P = 0.001), lower Glasgow coma scale score (10 vs 12, P < 0.001), higher head abbreviated injury scale (3.8 vs 3.3, P < 0.001), and higher injury severity score (25 vs 18, P < 0.001). The LOW group had a lower unadjusted mortality (10 vs 26%, P < 0.001). Multivariable analysis adjusting for confounders demonstrated that those resuscitated with ≥2 L of crystalloids had increased odds of mortality (adjusted odds ratio 2.25, P = 0.005). Higher volume crystalloid resuscitation after TBI is associated with increased mortality, thus limited resuscitation for TBI patients may be indicated.

The association of blood urea nitrogen levels with mortality in acute pulmonary embolism

BackgroundThe aim of this study was to investigate the association of BUN levels with in-hospital and long-term adverse clinical outcomes in acute pulmonary embolism (APE) patients treated with tissue-plasminogen activator (t-PA). MethodsThis retrospective study included 252 consecutive confirmed APE patients treated with t-PA. An admission BUN of 34.5 mg/dL was identified through an ROC analysis as an optimal cutoff value to predict the in-hospital mortality with 85% sensitivity and 91% specificity (AUC: 0.91; 95% CI: 0.84–0.96; P<.001). ResultsOur study showed that an increase in BUN levels was independently associated with a high risk of in-hospital all-cause mortality, low admission systolic blood pressure, use of inotropic drugs, and cardiogenic shock. In-hospital mortality rates were 51.1% in higher BUN group, and 1.9% in lower BUN group (P<.001). ConclusionIn this study, elevated admission BUN level was found to be a predictor of all-cause in-hospital mortality. BUN testing is commonly part of the basic metabolic panel; and it can be used to detect high-risk patients with APE, and it bears little risk, is inexpensive, and easy to perform.

Systolic Blood Pressure on Admission and Mortality in Patients Hospitalized With Acute Heart Failure: Observations From the Gulf Acute Heart Failure Registry.

We investigated the role of systolic blood pressure (SBP) in relation to in-hospital and postdischarge mortality in patients admitted with acute heart failure (AHF). The SBP of 4848 patients aged ≥18 years admitted with AHF was categorized into 5 groups: ≤90, 91 to 119, 120 to 139, 140 to 161, and >161 mm Hg. After adjusting for several confounders, multivariate logistic regression models showed that admission SBP was a significant predictor of mortality among both patients with preserved left ventricular function (defined as left ventricular ejection fraction [LVEF] ≥40%) and patients with left ventricular dysfunction (LVEF <40%). The adjusted odds ratios of in-hospital, 3-month, and 1-year mortality in the lowest SBP groups were 7.06 (95% confidence interval [CI]: 3.28-15.20; P < .001), 2.59 (95% CI: 1.35-4.96; P = .004), and 3.10 (95% CI: 2.04-4.72; P < .001) times the odds in the highest admission group (SBP > 161 mm Hg), respectively. We conclude that low admission SBP is an independent predictor of mortality in patients with AHF. The higher the admission SBP, the better the prognosis, regardless of age or LVEF.

MPS 04-07 SHORT AND MID-TERM OUTCOMES OF ACUTE MYOCARDIAL INFARCTION WITH ELEVATED SYSTOLIC BLOOD PRESSURE ON ADMISSION

Objective: Although lower admission systolic blood pressure (SBP) has been established as a poor prognostic factor in patients with acute myocardial infarction (AMI), the impact of preserved admission SBP on short and mid-term outcomes has not been fully evaluated. Design and Method: From January 2013 to March 2015, 1281 consecutive patients with AMI were registered in Mie ACS Registry, a prospective, multicenter registry in Japan. We evaluated 1122 patients (mean age 68 ± 13 years, male 78%) except for 159 patients with admission SBP < 100 mmHg. Patients were divided into three groups according to admission SBP: 100–139 mmHg (normal admission SBP; NBP group, n = 612), 140–179 mmHg (moderately elevated admission SBP; MBP group, n = 419) and ≥180 mmHg (excessively elevated admission SBP; EBP group, n = 91). The clinical characteristics, 30-day and 1-yaer outcomes (follow-up rate 94.7%) were compared among the three groups. Results: The rate of primary percutaneous coronary intervention and the number of diseased coronary vessels were not significantly different among the three groups. The Killip classification and the peak creatine kinase values were lowest in the MBP group. Heart failure, arrhythmia, shock and multi-organ failure during hospitalization were most often in the NBP group, but myocardial rupture was no significant difference in the three groups. The 30-day cumulative mortality was trend to be high in the NBP group (6.5%, 3.3% and 4.4% for NBP, MBP and EBP group, respectively, Log-Rank P = 0.069), and 1-year cumulative mortality after hospital discharge was significantly high in NBP group (5.5%, 1.6% and 2.4% for NBP, MBP and EBP group, respectively, Log-Rank P = 0.007) than other two groups (Figure). Conclusions: Admission SBP of less than 140 mmHg can be a risk of hemodynamic instability during hospitalization and an indicator of poor outcomes after hospital discharge in patients with AMI and preserved admission SBP.

Admission systolic blood pressure and outcomes in large vessel occlusion strokes treated with endovascular treatment

Background and purposeHigh admission blood pressure (BP) levels have been associated with lower recanalization rates after endovascular treatment (EVT) for patients with acute ischemic stroke (AIS) with emergent large vessel...

The association between admission systolic blood pressure of heart failure patients with preserved systolic function and mortality outcomes

IntroductionHeart failure is a major cause of death and disability and poses a significant public health concern. Approximately half of the patients admitted with heart failure, have preserved left ventricular ejection fraction. The association between systolic blood pressure (SBP) and long-term outcome in this group has not been well established. AimThe aim of our study is to evaluate the association between admission SBP and short term and long-term mortality outcomes in patients with heart failure and preserved systolic function. Methods1230 consecutive patients presenting with preserved left ventricular (LV) systolic function (defined as an LV ejection fraction ≥40%) were included in this survey. Patients were divided into quartiles according to admission SBP: low admission SBP (<127mmHg), intermediate admission SBP (128–145mmHg), high admission SBP (146–170mmHg) and very-high admission SBP (>170mmHg). Primary outcome included in hospital, one and four year mortality rates. ResultsElevated admission SBP was found to be associated with improved short and long-term mortality (HR=0.25 95% CI — 0.09–0.7, p=0.007 and HR=0.7 95% CI — 0.56–0.88, p=0.002 for the highest versus low SBP group, respectively). This finding was most notable in patients with acute heart failure and patients with ejection fraction≥50%. ConclusionElevated admission SBP is associated with a favorable short and long-term outcome in patients with heart failure and preserved systolic function. Key messageLow admission SBP is an independent predictor for short and long-term mortality in patients with HF and PSF.

Impact of Admission Systolic Blood Pressure and Antecedent Hypertension on Short-Term Outcomes After ST-Segment Elevation Myocardial Infarction: Strobe-Compliant Article.

We evaluated the combined effect of admission systolic blood pressure (SBP) and antecedent hypertension on short-term outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Data were derived from a multicenter survey of 7303 consecutive patients with STEMI. Patients were divided into 4 groups according to different blood pressure status: high SBP without hypertension, high SBP with hypertension, low SBP without hypertension, and low SBP with hypertension. The primary endpoints were 7 and 30-day all-cause mortality. The prevalence of hypertension was 40.7%, and the best cutoff of admission SBP for predicting 30-day mortality was 108 mmHg by receiver-operating characteristic curve. Patients with hypertension were older, more often female, also had longer onset-to-admission time, more comorbidities, and higher Killip class. Patients with both low SBP (≤108 mmHg) and hypertension group had significantly higher 7 and 30-day mortality than those in other groups (all P < 0.001). After multivariate adjustment, low SBP with hypertension group was still an independent risk factor for predicting 7-day mortality (hazard ratios [HR] 1.86, 95% confidence interval [CI] 1.41-2.46; P < 0.001) and 30-day mortality (HR 1.88, 95% CI 1.46-2.43; P < 0.001). In patients with SBP > 108 mmHg, a history of hypertension could increase the risk of 30-day mortality by 27% (HR 1.00 vs 1.27, P = 0.012), while in patients with SBP ≤ 108 mmHg, this increased risk reached to 37% (HR 1.51 vs 1.88, P < 0.001). In conclusion, low admission SBP was the relatively dominant contributor for predicting 7 and 30-day all-cause mortality, and a concurrent antecedent hypertension increased the corresponding risk of mortality.