Critical Closing and Tissue Perfusion Pressures in Sepsis: Implications for Risk Stratification-A Retrospective...

Area of Science:

• Critical care medicine
• Hemodynamics
• Sepsis pathophysiology

Background:

• Optimal mean arterial pressure (MAP) targets in sepsis management are debated.
• Critical closing pressure (Pcc) and tissue perfusion pressure (TPP) are key hemodynamic parameters influencing tissue perfusion.
• Evaluating the prognostic utility of Pcc and TPP can enhance sepsis risk stratification.

Purpose of the Study:

• To assess the prognostic value of Pcc and TPP in patients with sepsis.
• To determine if Pcc and TPP improve risk stratification compared to MAP alone.
• To investigate the association of Pcc and TPP with mortality and acute kidney injury (AKI) in sepsis.

Main Methods:

• Retrospective cohort study of 6,769 adult sepsis patients across 18 hospitals.
• Pcc estimated via linear regression; TPP calculated as MAP minus Pcc.
• Patients stratified into four groups based on Pcc and TPP thresholds; outcomes analyzed including mortality and AKI; external validation using MIMIC-IV cohort.

Main Results:

• ICU mortality was significantly higher in the Low TPP-Low Pcc group (35.1%) compared to the High TPP-High Pcc group (20.1%).
• A U-shaped association was observed between increased Pcc and reduced TPP with higher mortality and AKI rates (P < 0.001).
• Findings were consistent across independent datasets and external validation cohort.

Conclusions:

• Pcc and TPP provide complementary prognostic information to MAP in sepsis management.
• Integration of Pcc and TPP into clinical assessments may enhance risk stratification.
• Optimizing blood pressure management in sepsis may benefit from considering Pcc and TPP.