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Published on: March 22, 2024
Blood Pressure Response Index and Mortality in Patients With Cardiogenic Shock: A Multicenter Retrospective Cohort
Xiaodong You1, Yi Zhu1, Zhongman Zhang1
1Department of Emergency Medicine The First Affiliated Hospital with Nanjing Medical University Nanjing China.
Insights
The blood pressure response index (BPRI) effectively predicts mortality in cardiogenic shock (CS) patients. This index aids early risk detection and clinical decision-making for improved patient outcomes.
Area of Science:
- Critical Care Medicine
- Cardiovascular Research
- Medical Informatics
Background:
- The blood pressure response index (BPRI) is a validated tool for assessing cardiovascular response in septic shock.
- Its utility and predictive value in cardiogenic shock (CS) outcomes remain underexplored.
Purpose of the Study:
- To investigate the association between BPRI and in-hospital mortality in patients with CS.
- To evaluate BPRI's predictive performance compared to existing risk scores.
- To develop and validate a novel prediction model for CS mortality using BPRI.
Main Methods:
- Retrospective analysis of CS patient data from MIMIC-IV and eICU-CRD databases.
- Receiver operating characteristic (ROC) curve analysis to assess predictive ability for in-hospital mortality.
- Restricted cubic splines and segmented logistic regression to explore the BPRI-mortality relationship.
- Development and validation of a new CS prediction model.
Main Results:
- BPRI demonstrated superior predictive accuracy for in-hospital mortality compared to SOFA, BOS, and MA2 scores in both cohorts.
- An L-shaped association was observed between BPRI and in-hospital mortality, with a cutoff of 2.4 identified.
- The novel BPRI-based model showed strong predictive performance (AUC=0.799).
Conclusions:
- BPRI is a potent predictor of in-hospital mortality in ICU patients with CS.
- Early application of BPRI can facilitate mortality risk warning, guide clinical decisions, and aid risk stratification.
Background:
The blood pressure response index (BPRI) is an easy, rapid, precise dose-effect index to reflect the cardiovascular response of patients with septic shock. However, the relationship between BPRI and clinical outcomes in patients with cardiogenic shock (CS) has not been elucidated.
Methods:
We extracted the clinical data of patients with CS admitted to the ICU from the MIMIC-IV (v3.1) database and the eICU Collaborative Research Database (eICU-CRD). The predictive ability for in-hospital mortality was evaluated using the receiver operating characteristic curve. The relationship between BPRI and in-hospital mortality was explored utilizing restricted cubic splines, segmented logistic regression, and subgroup analysis. A new prediction model for CS was established and assessed by receiver operating characteristic curves and decision curve analysis.
Results:
There were 1456 and 386 patients in the MIMIC-IV and eICU-CRD cohorts, respectively. BPRI had a better area under the receiver operator characteristic curve for predicting in-hospital mortality than sequential organ failure assessment (SOFA) score and BOS, MA2 risk score in both MIMIC-IV and eICU-CRD cohort. We found an L-shaped association between BPRI and in-hospital mortality (P for nonlinear <0.001), with the cutoff values at 2.4 in both cohorts. The newly developed model utilizing BPRI demonstrated a good predictive ability for in-hospital mortality among patients with CS (area under the curve=0.799).
Conclusions:
BPRI is a powerful predictor for in-hospital mortality among patients with CS admitted to the ICU. The application of BPRI can help clinicians achieve early warning of mortality risk and early decision-making, guide the use of vasoactive drugs, and assist the risk stratification.
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