Association between initial diastolic arterial pressure and gastrointestinal dysfunction during the first ICU week in...

While diastolic arterial pressure (DAP) is critical for splanchnic perfusion, its relationship with gastrointestinal (GI) dysfunction remains understudied. This study aimed to investigate the rationale that DAP levels are associated with the development of GI symptoms in patients with septic shock. In this retrospective observational study, data were extracted from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Adult patients with septic shock were included, standardized to those maintaining a mean arterial pressure (MAP) ≥ 65 mmHg. Based on population percentiles, patients were categorized into three DAP strata: < 55, 55-65, and ≥ 65 mmHg. GI symptoms were documented daily during the first week after ICU admission. In total, 1990 eligible patients with an ICU stay ≥ 7 days were included. During the first week, 52.8% of patients experienced three or more GI symptoms. Most notably, multivariable analysis functioned as the primary finding, identifying that a DAP ≥ 65 mmHg was a significant protective factor against the development of GI symptoms (odds ratio [OR], 0.749; 95% confidence interval [CI], 0.592-0.948; P = 0.042). Furthermore, a DAP ≥ 65 mmHg was associated with a significantly lower incidence of diarrhea (9.9% vs. 17.5% vs. 22.4% in the high, intermediate, and low DAP groups, respectively; P < 0.001) and gastrointestinal bleeding (16.6% vs. 23.3% vs. 26.2% in the high, intermediate, and low DAP groups, respectively; P = 0.002) compared to the lower DAP strata. To our knowledge, this is the first study to evaluate the link between DAP and GI complications. Higher DAP levels were associated with reduced risk of GI symptoms, suggesting DAP may be a potential hemodynamic target worthy of prospective investigation.