Minimum Blood Pressure Research Articles

Blood Pressure Changes in Adolescents with Preeclampsia: A Multicentre, Case-Control Study in Latin American Hospitals

ObjectiveTo determine the minimum blood pressure increases that would confirm or exclude, with the greatest predictive values, hypertensive disorders of pregnancy (HDP) in pregnant adolescents after 24 weeks gestation. MethodsWe conducted a case-control study of pregnant women aged ≤19 years with and without HDP. Using systolic and diastolic blood pressure increases, a predictive analysis was performed, and the area under the curve was calculated. ResultsThe cases and controls had systolic blood pressure increases of 45.3 ± 17.5 mm Hg and 6.4 ± 7.9 mm Hg, respectively (P = 0.001) and diastolic blood pressure increases of 30.8 ± 11.7 mm Hg and 3.5 ± 5.7 mm Hg, respectively (P = 0.001). Systolic and diastolic increases of ≥20 mm Hg showed the greatest sensitivity and specificity. A combined analysis showed that an increase of ≥20 mm Hg had a greater positive likelihood ratio of 35.4 (95% CI 22.4–55.9) and negative likelihood ratio of 0.10 (95% CI 0.07–0.13), with an area under the curve of 0.98 (95% CI 0.96–0.99). ConclusionsSystolic and diastolic blood pressure increases of ≥20 mm Hg must be considered in the diagnostic criteria for preeclampsia and gestational hypertension among pregnant adolescents past 24 weeks gestation.

Moth Monarch Optimization-Based Deep Belief Network in Deception Detection System

Deception is the action of causing a person to believe something, which is known to be lying with the provision of evidence to support such false beliefs with certain intensions. Identification of the deceptive characteristics manually is a challenging problem for the researchers. Thus, an automatic deception detector is necessary to be developed in order to ensure higher accuracy. Accordingly, this paper proposes a novel deception detector method called Moth Monarch optimization-based Deep Belief Neural Network (MMO-DBN). The proposed MMO-DBN classifier undergoes the phases of feature extraction and classification. Initially, the input speech signals are pre-processed to remove the noise present in the signal and subjected to feature extraction to extract the significant features, such as Mel Frequency Cepstral Coefficients (MFCC), Spectral Kurtosis, Spectral Spread, Spectral Centroid, minimum blood pressure, maximum blood pressure, respiration rate, and Tonal Power Ratio. Then, these extracted features are subjected to classification using Deep Belief Neural Network (DBN), which is trained with the proposed Moth Monarch optimization (MMO) algorithm that is the integration of Monarch Butterfly Optimization (MBO) and Moth Search (MS) algorithm. The performance of the proposed MMO-DBN is analyzed using the metrics, namely accuracy, sensitivity, and specificity. The proposed method obtained the higher accuracy, sensitivity, and specificity of 0.984, 0.9836, and 0.9375, respectively that shows the superiority of the proposed MMO-DBN in deception detection.

Clinical risk factors associated with recurrence of ischemic stroke within two years: A cohort study.

To identify the clinical risk factors and investigate the efficacy of a classification model based on the identified factors for predicting 2-year recurrence after ischemic stroke.From June 2017 to January 2019, 358 patients with first-ever ischemic stroke were enrolled and followed up in Shenzhen Traditional Chinese Medicine Hospital. Demographic and clinical characteristics were recorded by trained medical staff. The outcome was defined as recurrence within 2 years. A multivariate logistic regression model with risk factors and their interaction effects was established and evaluated.The mean (standard deviation) age of the participants was 61.6 (12.1) years, and 101 (28.2%) of the 358 patients were female. The common comorbidities included hypertension (286 patients, 79.9%), diabetes (148 patients, 41.3%), and hyperlipidemia (149 patients, 41.6%). The 2-year recurrence rate was 30.7%. Of the 23 potential risk factors, 10 were significantly different between recurrent and non-recurrent subjects in the univariate analysis. A multivariate logistic regression model was developed based on 10 risk factors. The significant variables include diabetes mellitus, smoking status, peripheral artery disease, hypercoagulable state, depression, 24 h minimum systolic blood pressure, 24 h maximum diastolic blood pressure, age, family history of stroke, NIHSS score status. The area under the receiver operating characteristic curve (ROC) was 0.78 (95% confidence interval: 0.726–0.829) with a sensitivity of 0.61 and a specificity of 0.81, indicating a potential predictive ability.Ten risk factors were identified, and an effective classification model was built. This may aid clinicians in identifying high-risk patients who would benefit most from intensive follow-up and aggressive risk factor reduction.The clinical trial registration number: ChiCTR1800019647

Study on the stress response of young passengers in different subway passenger densities

In this study, we set up a virtual subway car and analyzed the stress response of young passengers in different compartments. A total of 10 volunteers participated in the experimental study. We measured their diastolic blood pressures, systolic blood pressures, and heart rates, from a car density of one person per square meter to a density of 10 persons per square meter, using 37° sport wristbands. The results show that the participants’ mean, minimum, and maximum heart rates were within the normal range, but the ratio of their mean to their maximum heart rate was 73.69%, a level that would have an impact on human health. Their mean, minimum, and maximum diastolic blood pressures and systolic blood pressures were within the normal range. Passenger density had no significant effect on diastolic blood pressure, systolic blood pressure, or heart rate (p < 0.05). Diastolic and systolic blood pressures were significantly positively correlated, whereas diastolic blood pressure and heart rate, and systolic blood pressure and heart rate, were negatively correlated, although not significantly. For the sake of comfort, we recommend five persons per square meter as the critical value of congestion.

Impacts of Coronary Artery Calcification on Intradialytic Blood Pressure Patterns in Patients Receiving Maintenance Hemodialysis.

Intradialytic blood pressure abnormalities are associated with adverse outcomes in patients with end-stage renal disease on dialysis. Vascular calcification is a common complicating feature, but whether this complication results in intradialytic blood pressure abnormalities remains uncertain. Therefore, this study investigated the relationship between coronary artery calcium score and intradialytic blood pressure abnormalities in patients with end-stage renal disease on maintenance hemodialysis. Thirty-six patients who received nongated chest computed tomography scans were included. Intradialytic hypotension was defined as a minimum intradialytic systolic blood pressure of <100 mmHg or a pre-dialysis blood pressure – minimum intradialytic systolic blood pressure >30 mmHg. Intradialytic hypertension was defined as >10 mmHg increase in systolic blood pressure (pre- to post-dialysis). Patients were classified as 22 (61.1%) with coronary artery calcium score <400 and 14 (38.9%) with coronary artery calcium score ≥400. Median systolic and diastolic blood pressures were equivalent, but median pulse pressure was higher in patients with coronary artery calcium score ≥400 than in those with scores <400. Coronary artery calcium score was comparable according to both intradialytic hypotension and hypertension, and had no correlation with systolic blood pressure fall and nadir systolic blood pressure. Coronary artery calcium score predicted the occurrence of cardiovascular events and all-cause mortality (hazard ratio 1.001 and 1.001; p=0.058 and 0.010). Coronary vascular calcification could be irrelevant to intradialytic blood pressure abnormalities in patients with end-stage renal disease on dialysis.

Is Spinal Dexmedetomidine Aggravating Hypotension after Tourniquet Deflation?

Background and Aims:The addition of dexmedetomidine to spinal anesthesia decreases the incidence of tourniquet pain but may aggravate hypotension after tourniquet deflation.Methods:Fifty patients were included in this prospective, double-blinded, randomized study, randomly divided into two equal groups of 25 patients each. Spinal anesthesia was performed using 2.5 mL of 0.5% hyperbaric bupivacaine plus 0.5 mL of normal saline in control group (Group C) or 2.5 mL of 0.5% hyperbaric bupivacaine plus 0.5 mL (5 μg) of dexmedetomidine in (Group D). Tourniquet pain was treated by 50 mg of meperidine and repeated in a dose of 20 mg, and the total meperidine consumption was calculated. After tourniquet deflation, heart rate and mean blood pressure were measured for 15 min in the operating room and at these times: before induction of anesthesia (baseline), after inflating tourniquet (inflation), 1 min before deflating tourniquet (predeflation), after tourniquet deflation (10 min postdeflation), and maximum blood pressure and heart rate changes. Duration of time that started before the minimum blood pressure and maximum heart rate was changed until recovery was recorded.Results:Pain after torniquet inflation was significantly higher in the Group C compared to the Group D. The maximal change of blood pressure was lower in the dexmedetomidine than in the control group. The mean time between the maximal change in blood pressure reached and started to recover was 135 ± 14 s in the dexmedetomidine group and 80 ± 31 s in the control group (P < 0.01) and maximal heart rate change was lower in dexmedetomidine group than the control group. The time between the maximal heart rate changes until recovery was 113.2 ± 19 s in the dexmedetomidine group and 53.2 ± 11 s in the control group P < 0.01.Conclusion:Adding dexmedetomidine to spinal anesthesia decreases the incidence of tourniquet pain but aggravates the hemodynamic effect of tourniquet deflation.

Vasopressors for managing maternal hypotension during cesarean section under spinal anesthesia: A systematic review and network meta-analysis

Introduction: Spinal anesthesia during elective cesarean section often induces maternal hypotension, and vasopressors are the most reliable agents to counteract this. We conducted a systematic review and network meta-analysis to compare and specifically evaluate the efficacy of vasopressors in preventing maternal hypotension (effectiveness) and decreasing fetal acidosis (safety) in parturients undergoing spinal anesthesia for cesarean section. Methods: We performed a systematic and comprehensive search to identify all randomized controlled studies on vasopressors to manage maternal hypotension during cesarean section under spinal anesthesia, which had been published until June 30, 2019 and updated until September 20, 2020. A network meta-analysis was conducted to combine direct and indirect comparisons of vasopressors. The primary outcomes included minimum systolic blood pressure, the incidence of hypotension, and fetal acidosis. Stata SE 15.0 was used for the meta-analysis. Results: Forty-five studies (n = 3,369) with six different vasopressors injected using various methods were included. Based on the surface under the cumulative ranking curve (SUCRA) value, intravenous (IV) continuous infusion of mephentermine (SUCRA value 83.4%) was the most efficacious vasopressor with the lowest incidence of hypotension, followed by continuous infusion of ephedrine with norepinephrine bolus (81.6%) and norepinephrine (76.4%). Compared with an IV bolus injection, all analyzed vasopressors were more effective when they were infused continuously for managing maternal hypotension. In terms of safety, only angiotensin II as an IV continuous infusion (94.7%) was efficacious in preventing fetal acidosis, resulting in a pH closer to 7.4, and there were no significant differences in umbilical arterial pH between the test and control groups. Conclusion: Clinicians should continuously infuse vasopressors to manage maternal hypotension during cesarean section under spinal anesthesia. According to SUCRA, norepinephrine administered as an IV continuous infusion was the third most efficacious vasopressor with the lowest incidence of maternal hypotension, and it could be a potential alternative to phenylephrine. Meanwhile, only angiotensin II administered as an IV continuous infusion caused less umbilical arterial acidosis than the control group.

The surgical effect on obstructive sleep apnea with laryngopharyngeal reflux

Objective:To explore the effect of surgical treatment for OSA with laryngopharyngeal reflux（LPR）. Method:A retrospective analysis was made in 42 patients diagnosed as moderate to severe OSA with LPR and treated with modified-coblation assisted Uvulopalatopharyngoplasty（M-CAUP）. The results of PSG, reflux symptom index（RSI）, reflux finding score（RFS） and 24-hour esophageal pH monitoring before and after operation were compared. Result:The AHI after operation was significantly lower than that before operation（P<0.05）, and the average oxygen saturation and minimum blood pressure saturation were increased（P<0.05）. The total scores of RSI and RFS after operation were lower than those before operation（P<0.05）. The percentage of time of pH<4.0 in esophagus 24 hours after operation was lower than that before operation（P<0.05）. Conclusion:For patients with moderate to severe OSA combined with LPR with oropharyngeal obstruction, surgical treatment can not only reduce airway stenosis and obstruction, but also improve the symptoms and signs of LPR.

Utilization of age-adjusted shock index in a resource-strained setting

BackgroundIdentification of injury severity and appropriate triage are critical to effective surgical care, especially where medical and surgical resources are strained. We hypothesized that pediatric age-adjusted shock index (SIPA) would outperform traditional shock index (SI) in a middle-income country (MIC) setting. MethodsInjured children hospitalized in two trauma centers (South Africa and the United States) from 2012 to 2017 were reviewed. Maximum heart rate and minimum systolic blood pressure defined SI. SI > 0.9 defined elevation. SIPA elevation was based on SI stratified by age: 1–6 years (SI > 1.22), 7–12 years (SI > 1.0), and 13–17 years (SI > 0.9). SI and SIPA were compared using univariate analyses and area under the receiver operating characteristic curves (AUROC). Results1648 patients (741 MIC and 907 high-income country (HIC)) were evaluated with a median [IQR] age of 11 [6–15] years. SI was elevated in 377 (51%) MIC children, whereas SIPA was elevated in 248 (34%). In both the HIC and MIC, elevated SIPA was more associated with ISS ≥ 25, ICU admission, and mortality. In MIC patients specifically, elevated SIPA improved discrimination for in-hospital mortality (AUROC 0.66 vs AUROC 0.57, p < 0.01). ConclusionIn a multinational cohort including MIC patients, SIPA facilitated identification of injured children with altered physiology, reflecting greater injury severity and poorer outcomes. Use of SIPA has the potential for more effective resource utilization in MICs. Level of evidenceLevel III.

Comparative study of ambulatory blood pressure monitoring in hemodialysis and non-dialysis CKD patients and their prognostic value

Background: Hypertension and chronic kidney disease are inextricably intertwined. Most patients with hypertension associated CKD die of heart attack and stroke before renal function. Ambulatory BP monitoring provides automated measurements of BP during a 24hrs period while patients engaged in their usual activities including sleep. Recommended normal value include an average daytime BP &lt;135/85mmHg/night time BP &lt;120/70mmHg and 24 hr BP &lt;130/89mmHg. In patients with chronic kidney disease the control of hypertension slows the progression of end stage renal disease. This study was undertaken to define the prognostic role of ABPM in dialysis dependent and non-dialysis CKD patients so that better treatment strategies could be initiated to prevent adverse outcomes.Methods: This prospective cross sectional study was conducted at Aarupadai Veedu Medical College and hospital, Puducherry in both dialysis dependent and non-dialysis CKD patients admitted in both ICU and medical wards. APBM was performed by using the properly validated ambulatory blood pressure monitor. The monitor records BP on the non-dominant arm every 20 minutes while awake and hourly while sleep for a total duration 24hrs in both hemodialysis dependent and non-hemodialysis patients. In hemodialysis dependent patients ABPM was recorded on the second day of hemodialysis.Results: The mean maximum systolic blood pressure in dialysis dependent and non-dialysis CKD patients recorded was 146.23 and 166.12 mmHg respectively. The mean minimum systolic blood pressure in dialysis dependent and non-dialysis CKD patients recorded was 122.11 and 122.45 mmHg respectively. The mean maximum diastolic blood pressure in dialysis dependent and non-dialysis CKD patients recorded was 100.24 and 110.65mmHg respectively. The mean minimum diastolic blood pressure in dialysis dependent and non-dialysis CKD patients recorded was 78.65 and 80.67 mmHg respectively. In our study the prevalence of non-dipping in dialysis and non-dialysis CKD patients were 28% and 16% respectively.Conclusions: Ambulatory blood pressure monitoring is considered the gold standard for the diagnosis of hypertension. Tight BP control is needed to limit the progression of renal disease and lessen cardiovascular morbidity and mortality. To achieve this goal ABPM should be widely adopted in patients with CKD.

Prevalence of Obesity and Hypertension Among the Zou Mothers of Manipur, Northeast India

The present study was conducted to find out the prevalence of overweight/obesity and hypertension among the Zou mothers, a tribal population of Manipur state. A cross-sectional study was conducted among 533 mothers who are within their reproductive stages of age 17–49 years following house-to-house visits. The subjects were divided into different age groups to examine the influence of age on their health condition. The finding shows that the mean systolic and diastolic blood pressure increases along with advancing age group. The cut-off value of BMI for both categories of Asian population and WHO international shows that there is a positive association between different BMI categories and blood pressure (BP). Minimum BP was found among underweight and maximum among obese category. BP was found the lowest among the younger age group and the highest among the menopausal mothers. Although the magnitude of correlation differed, there was a significant positive correlation among BMI, systolic, diastolic, and age. The effect of changing socioeconomic environment and sedentary lifestyle in addition to inactive physical activities could be the main reasons for prevalence of overweight and obesity in study population.

Abstract TMP3: Blood Pressure Variability Within 24 Hours After Mechanical Thrombectomy Correlates With Worse Outcome

Introduction: blood pressure variability (BPV) in the acute phase following ischemic stroke is associated with worse outcomes, especially in patients with large vessel occlusions. However, the relationship between BPV and outcome after successful recanalization is not well documented. Objective: The aim of this study was to evaluate the association between BPV and outcome after successful recanalization. Methods: This was a retrospective multicenter study of patients with anterior circulation large vessel occlusions who achieved successful recanalization with MT. Successful recanalization was defined as TICI≥2b. BP was recorded in hourly intervals for 24 hours post MT. BPV was defined as the difference between maximum and minimum blood pressure within 24 hours. BPV was calculated for mean arterial pressure (MAP), systolic BP (SBP), and diastolic BP (DBP). Outcome measures included 90 days mRS, symptomatic ICH (sICH), and mortality. sICH was defined based on ECASS criteria. Good outcome was defined as mRS 0-2. Results: A total of 985 patients were included. SBP and MAP variability were higher in poor outcome group (65.2±26 vs. 57± 24.6; p &lt;0.001, and 49.7±21.2 vs. 46.9± 22.3; p=0.048 respectively). Likewise, SBP and MAP variability were higher in sICH group. The association between SBP variability and 90 day mRS, sICH, and mortality remained significant after adjusting for potential confounders. Conclusion: Higher blood pressure variability was associated with worse functional outcomes, higher likelihood of symptomatic hemorrhage, and increased mortality.

Evaluation of the Effect of Dexmedetomidine on Hemodynamic Changes and Recovery Time in Patients Undergoing Dilatation and Curettage

Background: Because of the traditional use of propofol drugs for relaxation in dilatation and curettage is used. Recently, doctors have taken into consideration the importance of dexmedetоmidine treatment. Since quantitative reports on the use of long-acting diuretics in the practice of dilatation and curettage, this study aimed to compare the effect of dexmedetоmidine and placebo (normal saline) on the rate of patient recovery instead, the amount of pain in recovery and hemodynamic parameters, and the need for drugs and hypnosis drugs. Methods: This double blind clinical trial was conducted between two groups of 50 patients with dexmedetоmidine (D) and placebo (P). At first, group D received 1μg/kg dose of dexmedetоmidine for 10 minutes and P group received 1μg/kg normal saline for 10 min. Then, 2 mg/kg fentanyl and both groups received 1.5 mg anesthetic Injecting propofol per kilogram to Ramsey relaxation score of 3-4, and during the hemodynamic operation, it was recorded and compared with the amount of opioid and propofol needed. Results: In group D, the maximum blood pressure and minimum blood pressure in the 5th minute after the start of the operation were significantly different with the P group (P<0.05). Also, in group D, heart rate was significantly different in the 5th and 10th minutes after surgery with P group (P<0.05). There was a significant difference between groups in D group with recovery group (P<0.05). Conclusion: Since the use of Dexmedetomidine in comparison with placebo has hemodynamic stability, the patient's greater satisfaction and less pain in recovery, it is deduced that Dexmedetоmidine is a suitable alternative for short-term surgery.

Dexmedetomidine is safe and reduces the additional dose of midazolam for sedation during endoscopic retrograde cholangiopancreatography in very elderly patients

BackgroundEndoscopic retrograde cholangiopancreatography (ERCP) often requires deep sedation. Dexmedetomidine, a highly selective α2-adrenoceptor agonist with sedative activity and minimal effects on respiration, has recently been widely used among patients in the intensive care unit. However, its use in endoscopic procedures in very elderly patients is unclear. In this study, we retrospectively investigated the safety and efficacy of dexmedetomidine sedation during ERCP.MethodsThe study included 62 very elderly patients (aged over 80 years) who underwent ERCP from January 2014, with sedation involving dexmedetomidine (i.v. infusion at 3.0 μg/kg/h over 10 min followed by continuous infusion at 0.4 μg/kg/h) along with midazolam. For comparison, the study included 78 patients who underwent ERCP before January 2014, with midazolam alone. We considered additional administration of midazolam as needed to maintain a sedation level of 3–4, according to the Ramsay sedation scale. The outcome measures were amount of midazolam, adverse events associated with sedation, and hemodynamics.ResultsThe incidence of decreased SpO2 and median dose of additional midazolam were significantly lower in the dexmedetomidine group than in the conventional group. The minimum systolic blood pressure and minimum heart rate during and after examination was significantly lower in the dexmedetomidine group than in the conventional group. However, serious acute heart failure or arrhythmia was not noted.ConclusionsDexmedetomidine can decrease the incidence of respiratory complications and the total dose of other sedative agents. It can be used as an alternative to conventional methods with midazolam for adequate sedation during ERCP in very elderly patients.

An Analytical Study on Mechanical Behavior of Human Arteries – A Nonlinear Elastic Double Layer Model

The focus of this article is on analytical solution for stress and deformation of human arteries. The artery is considered as a long homogeneous isotropic cylinder. Hyperelastic, incompressible stress-strain behavior is used by adopting a classical Mooney-Rivlin material model. The elastic constants of the arteries are calculated by using the reported results of biaxial test. The analysis is based on both single and double layer arterial wall models and. Radial and circumferential stress distribution on the minimum and maximum blood pressure is calculated. Variation of radii due to internal pressure within the arteries is found which is in a good accordance with the experimental results. The results containing the changes in diameter and thickness together with the stress distribution for both single and double layer models have been plotted. It is shown that the major difference between the single and double layer models is in their stress distributions. The circumferential stress distribution for different human’s ages is plotted which shows that the stress increases by increasing the age due to decreasing the flexibility of the artery. It is also shown that despite the artery’s inner layer is softer than the outer layer, the maximum stresses occur at the inner layer.

Effects of Glucose and Blood Pressure Variability on Oxidative Stress in Type 2 Diabetes with Hypertension

Aims: This study was performed to evaluate the effects of glucose variability (GV) and blood pressure variability (BV) on oxidative stress in type 2 diabetes patients with hypertension. Methods: Fifty-seven inpatients with type 2 diabetes (studied from May 2015 to august 2017) underwent continuous glucose monitoring (CGM) and ambulatory BP monitoring (ABPM) in a cross-sectional study. The plasma total oxidant capacity against N,N-diethylparaphenylendiamine was measured as a marker of oxidative stress using the d-ROMs test. The GV, mean glucose level (MGL), mean amplitude of glycemic excursions (MAGE), and area under the postprandial plasma glucose curve (AUCPP) were measured by CGM. The BV, mean blood pressure (MBP), max blood pressure (MaxBP), minimum blood pressure (MinBP), and standard deviation of blood pressure (BPSD) during the systole (S) and diastole (D) were measured by ABPM over daytime (day), nighttime (night), and 24-hour (24) periods. Results: The 57 participants were 65.3±12.9 years old, with a disease duration of 14.7±12.4 years and HbA1c of 8.5±1.2 %. In univariate analysis, MAGE (r=0.446,p&amp;lt;0.001), night DBPSD (r=0.323,p=0.014), and eGFR (r=0.287, p=0.030) were significantly correlated with the d-ROMs. In the stepwise multiple regression analysis, MAGE (β=0.344, t=3.075, p=0.003), night DBPSD (β=0.230, t=2.034, p=0.047), eGFR (β=-0.234, t=-2.137, p=0.037), and smoking (β=0.315, t=2.873, p=0.006) were identified as independent factors contributing to the d-ROMs (multiple R2 = 0.363). Conclusions: Daily glucose variability and nighttime systolic blood pressure variability are associated with oxidative stress in type 2 diabetes with hypertension. Disclosure M. Ohara: None. H. Nagaike: None. T. Yamamoto: None. T. Hayashi: None. T. Fukui: None. T. Hirano: Speaker's Bureau; Self; Novo Nordisk Inc., AstraZeneca.

Visfatin levels in hormonally inactive adrenal adenoma and their association with metabolic parameters

Background/aim: In parallel with increased frequency and higher quality of imaging techniques, the prevalence of adrenal adenoma has gradually increased. However, despite the growing incidence, the metabolic and tumorigenesis processes involved in its etiology are still unclear. Although visfatin has been reported to be associated with inflammation and tumorigenesis, its role in adrenal adenoma has not yet been investigated. Therefore, the present study was performed with an aim to evaluate visfatin levels and cardiometabolic risk factors in patients with adrenal adenoma. Materials and methods: Thirty patients recently diagnosed with adrenal adenoma along with 30 healthy participants were studied in a tertiary healthcare center. Twenty-four-hour ambulatory blood pressure monitoring and carotid artery intima-media thickness (CIMT) measurements were performed. Results: The frequencies of diabetes mellitus and hypertension were found to be statistically higher in the adrenal adenoma group. Although the values of mean fasting glucose, insulin, HOMA-IR levels, and the mean, maximum, minimum, delta systolic, and diastolic blood pressures were established to be higher in the adrenal adenoma group, the differences were not found to be statistically significant. Mean high-sensitive C-reactive protein, visfatin levels, and CIMT were seen to be significantly higher in the adenoma group. Conclusion: Cardiometabolic risk factors as well as the visfatin levels were established to be higher in patients with adrenal adenoma. Elevated visfatin levels might play a role in the development and metabolic process of adrenal adenoma.

Risk factors and inpatient outcomes associated with acute kidney injury at pediatric severe sepsis presentation.

Little data exist on acute kidney injury (AKI) risk factors in pediatric sepsis. We identified risk factors and inpatient outcomes associated with AKI at sepsis recognition in children with severe sepsis. Retrospective, cross-sectional study with inpatient outcome description of 315 patients > 1month to < 20years old with severe sepsis in a pediatric intensive care unit over 3years. Exposures included demographics, vitals, and laboratory data. The primary outcome was kidney disease: Improving Global Outcomes creatinine-defined AKI within 24h of sepsis recognition. Factors associated with AKI and AKI severity were identified using multivariable Poisson and multinomial logistic regression, respectively. AKI was present in 42% (133/315) of severe sepsis patients, and 26% (83/315) had severe (stage 2/3) AKI. In multivariable-adjusted analysis, hematologic/immunologic comorbidities, malignancies, chronic kidney disease (CKD), abdominal infection, admission illness severity, and minimum systolic blood pressure (SBP) ≤ 5th percentile for age and sex within 24h of sepsis recognition were associated with AKI. Factors associated with mild AKI were CKD and abdominal infection, while factors associated with severe AKI were younger age, hematologic/immunologic comorbidities, malignancy, abdominal infection, and minimum SBP ≤ 5th percentile. Patients with AKI had increased hospital mortality (17 vs. 8%, P = 0.02) and length of stay [median 20 (IQR 10-47) vs. 16days (IQR 7-37), P = 0.03]. In pediatric severe sepsis, AKI is associated with age, comorbidities, infection characteristics, and hypotension. Future evaluation of risk factors for AKI progression during sepsis is warranted to minimize AKI progression in this high-risk population.

Blood pressure levels post mechanical thrombectomy and outcomes in non-recanalized large vessel occlusion patients

ObjectivePermissive hypertension may benefit patients with non-recanalized large vessel occlusion (nrLVO) post mechanical thrombectomy (MT) by maintaining brain perfusion. Data evaluating the impact of post-MT blood pressure (BP) levels on...

929: Risk factors for postpartum hospital readmission

to identify independent prenatal and intrapartum factors associated with postpartum readmissions This is a retrospective review of 644 (1.6%) women from 2013-2016 who had postpartum readmission within 6 weeks of delivery compared to 40693 (98.4%) controls. Independent variables included demographics, prenatal factors and intrapartum factors (labor complications, medication use and mode of delivery). Logistic regression and hierarchical analysis were used to determine independent associations. Readmission rate over the 4 years of the study was stable and ranged from 1.2%- 2.0%. 518 (80%) cases were readmitted for obstetrical reasons, while 126 (20%) cases were medical/surgical readmissions. Specific readmission diagnoses were hypertension 315 (48.9%), endometritis/puerperal sepsis 93 (14.4%), gastrointestinal disorders 54 (8.4%), postoperative complications 51 (7.9%), breast infections 31 (4.8%), post-partum hemorrhage 28 (4.3%), renal disease/infection 24 (3.8%), thromboembolism 11 (1.7%), mental disease 10 (1.6%) and cardiac disease 7 (1.7%). Mean number of days to readmission was 7.5 in patients with obstetric indications versus 19.9 for those with medical indications (p<0.001). Significant prenatal factors were advanced maternal age, body mass index, black race, nulliparity, hypertensive disorders, diabetes, prior cesarean delivery and tobacco use. Amongst Intrapartum factors: vital signs (maternal maximum temperature and minimum systolic blood pressure) and medication use (antihypertensive medications, magnesium therapy, gentamicin/clindamycin, uterotonics parenteral use of opioids and induction of labor medications) were significantly associated with readmission. Other independent associations were cesarean delivery and maternal length of stay (Table). Hierarchical analysis showed that intrapartum medication use significantly increased albeit by a small percentage the variability accounted for postpartum hospital readmission when controlled for all other independent factors. Most significant risk factors for readmission were hypertension, diabetes, magnesium therapy, uterotonics use and cesarean delivery. Medical cases of readmission present at a later interval than obstetrical indications. Intrapartum medication therapy is an important predictor of readmission.