Table_1_U-Shaped Association Between Blood Pressure and Mortality Risk in ICU Patients With Atrial Fibrillation: The MIMIC-III Database.XLS

BackgroundExisting evidence on the association between blood pressure (BP) and mortality risk in intensive care unit (ICU) patients with atrial fibrillation (AF) is scarce.
AimThis study aimed to assess the associations between blood pressure (BP) and risks of in-hospital and all-cause mortality in ICU patients with AF.
MethodsA total of 2,345 records of patients with AF whose BP was monitored after admission to the ICU were obtained from the MIMIC-III database. Incidences were calculated for endpoints (hospital mortality, 7-day mortality, 30-day mortality, and 1-year mortality). We performed smooth curve and logistic regression analyses to evaluate the association between BP and the risk of each endpoint.
ResultsSmooth curve regression showed that systolic blood pressure (SBP), mean arterial pressure (MBP), and diastolic blood pressure (DBP) followed U-shaped curves with respect to endpoints (hospital mortality, 7-day mortality, 30-day mortality, and 1-year mortality). The incidence of these endpoints was lowest at 110/70/55 mm Hg. There was an increased risk of 1-year mortality observed with BP > 110/70/55 mm Hg (SBP, odds ratio [OR] = 1.008, 95% CI 1.001–1.015, p = 0.0022; MBP, OR = 1.010, 95% CI 1.005–1.016, p < 0.001) after adjusting for age, sex, and medical history. In contrast, an inverse association between BP and the risk of 1-year mortality was observed with BP ≤ 110/70/55 mm Hg (SBP, OR = 0.981, 95% CI 0.974–0.988, p < 0.001; MBP OR = 0.959, 95% CI 0.939–0.979, p < 0.001; and DBP, OR = 0.970, 95% CI 0.957–0.983, p < 0.001).
ConclusionsWe observed a U-shaped association between BP and in-hospital/all-cause mortality in ICU patients with AF. However, the underlying causes need to be investigated.

研究背景：目前关于心房颤动（Atrial Fibrillation, AF）重症监护病房（Intensive Care Unit, ICU）患者血压（Blood Pressure, BP）与死亡风险之间关联的相关证据较为匮乏。研究目的：本研究旨在探讨心房颤动重症监护病房患者的血压与院内死亡率及全因死亡率之间的关联。研究方法：本研究从MIMIC-III数据库中提取了2,345例入院重症监护病房后接受血压监测的心房颤动患者的病历数据。针对研究终点（院内死亡率、7天死亡率、30天死亡率及1年死亡率）计算了事件发生率。本研究采用平滑曲线分析与逻辑回归分析，评估血压与各研究终点风险之间的关联。研究结果：平滑曲线回归分析显示，收缩压（Systolic Blood Pressure, SBP）、平均动脉压（Mean Arterial Pressure, MBP）及舒张压（Diastolic Blood Pressure, DBP）与各研究终点之间均呈U型关联。当血压处于110/70/55 mmHg时，各研究终点的事件发生率最低。在校正年龄、性别与病史后，当血压高于110/70/55 mmHg时，患者1年死亡风险升高（收缩压：优势比[OR]=1.008，95%置信区间[CI]1.001–1.015，p=0.0022；平均动脉压：OR=1.010，95%CI 1.005–1.016，p<0.001）。与之相反，当血压≤110/70/55 mmHg时，血压与1年死亡风险呈负相关关系（收缩压：OR=0.981，95%CI 0.974–0.988，p<0.001；平均动脉压：OR=0.959，95%CI 0.939–0.979，p<0.001；舒张压：OR=0.970，95%CI 0.957–0.983，p<0.001）。研究结论：本研究发现，心房颤动重症监护病房患者的血压与院内/全因死亡率之间呈U型关联，但该关联的潜在机制仍有待进一步探究。