Abstract
Background /Objective It is unclear if blood pressure variability’s (BPV) association with worse outcomes is unique to stroke patients or a risk factor among all critically-ill patients. We (1) determined if BPV differed between stroke and non-stroke patients, (2) examined BPV’s associations with in-hospital death and favorable discharge destination in stroke and non-stroke patients, and (3) assessed how minimum mean arterial pressure (MAP) – a correlate of illness severity and cerebral perfusion – impacts these associations.
Methods: This is a retrospective analysis of adult ICU patients hospitalized between 2001 and 2012 from the Medical Information Mart for Intensive Care III (MIMIC-III) database. Confounder-adjusted logistic regressions determined associations between BPV, measured as standard deviation (SD) and Average real variability (ARV), and a) in-hospital death and b) favorable discharge, with testing of minimum MAP for effect modification.
Results: BPV was higher in stroke patients (N=2,248) compared to non-stroke patients (N=9,085) (SD Mean difference: 2.3, 95% CI: 2.1-2.6, p<0.01). After adjusting for minimum tertile of MAP and other confounders, higher SD remained significantly associated (P <0.05) with higher odds of in-hospital death for patients with acute ischemic strokes (AIS, OR 2.7, 95% CI: 1.5-4.8), intracerebral hemorrhage (ICH, OR 2.6, 95% CI: 1.6-4.3), subarachnoid hemorrhage (SAH, OR 3.4, 95% CI: 1.2-9.3), and pneumonia (OR 1.9, 95% CI: 1.1-3.3); and lower odds of favorable discharge destination in patients with ischemic stroke (OR 0.3, 95% CI: 0.2-0.6) and intracerebral hemorrhage (OR 0.4, 95% CI: 0.3-0.6). No interaction was found between minimum MAP tertile with SD (P>0.05). Higher ARV was not significantly associated with increased risk of death in any condition when adjusting for illness severity, but portended worse discharge destination in those with AIS (ORfavorable discharge 0.4, 95% CI: 0.3-0.7), ICH (ORfavorable discharge 0.5, 95% CI: 0.3-0.7), sepsis (ORfavorable discharge 0.8, 95% CI: 0.6-1.0), and pneumonia (ORfavorable discharge 0.5, 95% CI: 0.4-0.8).
Discussion: BPV is higher and generally associated with worse outcomes among stroke compared to non-stroke patients. BPV in AIS and ICH patients may be a marker of central autonomic network injury, though clinician-driven blood pressure goals likely contribute to the association between BPV and outcomes.
- Received October 23, 2022.
- Accepted in final form May 15, 2023.
- © 2023 American Academy of Neurology
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