Minimal data set for MIMIC-III.

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 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.【背景】平均灌注压（mean perfusion pressure, MPP）近年被提出用于重症患者的个体化组织灌注压管理。MPP的剧烈波动可能与不良临床结局相关。本研究旨在探讨接受中心静脉压（central venous pressure, CVP）监测的重症患者中，更高的MPP变异性是否与住院死亡率升高相关。【方法】本研究为回顾性观察性研究，分析了eICU协作研究数据库（eICU Collaborative Research Database）中的数据，并在重症监护医学信息库III（Medical Information Mart for Intensive Care III, MIMIC-III）中开展验证试验。主要分析中，暴露因素为MPP变异系数（coefficient of variation, CV），数据取自患者首次ICU住院期间72小时内记录的前24小时MPP数据。主要研究终点为住院死亡率。【结果】本研究共纳入6111例患者，其住院死亡率为17.6%，MPP变异系数的中位数为12.3%。非存活者的MPP变异系数显著高于存活者（13.0% vs 12.2%，原文此处存在统计信息缺失），且MPP变异系数>19.2%的患者住院死亡风险较第五、第六十分位组患者升高（校正后优势比：1.38，95%置信区间：1.07~1.78）。该关联在多项敏感性分析中仍具有统计学显著性。针对4153例受试者的验证试验也证实，当MPP变异系数>21.3%时，上述结果成立（校正后优势比：1.46，95%置信区间：1.05~2.03）。【结论】在接受CVP监测的重症患者中，MPP的剧烈波动与短期住院死亡率升高显著相关。