Severe fluctuation in mean perfusion pressure is associated with increased risk of in-hospital mortality in critically ill patients with central venous pressure monitoring: A retrospective observational study

BackgroundThe mean perfusion pressure (MPP) was recently proposed to personalize tissue perfusion pressure management in critically ill patients. Severe fluctuation in MPP may be associated with adverse outcomes. We sought to determine if higher MPP variability was correlated with increased mortality in critically ill patients with CVP monitoring. MethodsWe designed a retrospective observational study and analyzed data stored in the eICU Collaborative Research Database. Validation test was conducted in MIMIC-III database. The exposure was the coefficient of variation (CV) of MPP in the primary analyses, using the first 24 hours MPP data recorded within 72 hours in the first ICU stay. Primary endpoint was in-hospital mortality. ResultsA total of 6,111 patients were included. The in-hospital mortality of 17.6% and the median MPP-CV was 12.3%. Non-survivors had significantly higher MPP-CV than survivors (13.0% vs 12.2%, p<0.001). After accounting for confounders, the highest MPP-CV in decile (CV > 19.2%) were associated with increased risk of hospital mortality compared with those in the fifth and sixth decile (adjusted OR: 1.38, 95% Cl: 1.07-1.78). These relationships remained remarkable in the multiple sensitivity analyses. The validation test with 4,153 individuals also confirmed the results when MPP-CV > 21.3% (adjusted OR: 1.46, 95% Cl: 1.05-2.03). ConclusionsSevere fluctuation in MPP was associated with increased short-term mortality in critically ill patients with CVP monitoring.

Automated summary

This study found that higher variability in mean perfusion pressure (MPP) was correlated with increased mortality in critically ill patients with central venous pressure (CVP) monitoring. Non-survivors had significantly higher MPP coefficient of variation (MPP-CV) compared to survivors. After controlling for confounding factors, the highest MPP-CV (>19.2%) was associated with an increased risk of hospital mortality. The validation test in the MIMIC-III database confirmed these results when MPP-CV was >21.3%.