3 mmHg; MAP quartile II = 74.3 to 77.8 mmHg; MAP quartile III = 77.8 to 82.1 Palbociclib FDA mmHg; …MAP or MAP quartiles were not associated with the total number of disease-related events (linear regression model; MAP: standardized Beta-Coefficient, -0.052; P = 0.36; MAP quartiles: standardized Beta-Coefficient, -0.035; P = 0.55) or the occurrence of any single disease-related event. These associations were not influenced by age or pre-existent arterial hypertension. However, the mean vasopressor load was significantly associated with the total number of disease-related events (standardized Beta-Coefficient, 0.225; P < 0.001). Figure Figure22 presents the predicted number of total disease-related events by MAP and mean vasopressor load quartiles as predicted by the adjusted logistic regression model.
The mean vasopressor load (per ln unit) was associated with the occurrence of acute circulatory failure (RR, 1.64; 95% CI, 1.28 to 2.11; P < 0.001), metabolic acidosis (RR, 1.79; 95% CI, 1.38 to 2.32; P < 0.001), renal failure (RR, 1.49; 95% CI, 1.17 to 1.89; P = 0.001) and thrombocytopenia (RR, 1.33; 95% CI, 1.06 to 1.68; P = 0.01) in single adjusted logistic regression models. Study patients still had a significantly lower mean and maximum vasopressor load during the shock period when compared with the 68 patients excluded from the analysis (mean vasopressor load, 0.64 �� 1.92 vs. 2.31 �� 6.56 ��g/kg/min, P = 0.003; maximum vasopressor load, 1.19 �� 3.54 vs. 3.06 �� 7.4 ��g/kg/min, P = 0.01) [Figure S1 in Additional data file 1].
Figure 2Number of DRE by MAP and mean vasopressor load quartiles as predicted by the adjusted logistic regression model. Mean arterial blood pressure (MAP) quartile I = 70 to 74.3 mmHg; MAP quartile II = 74.3 to 77.8 mmHg; MAP quartile III = 77.8 to 82.1 mmHg; …The mean heart rate during the shock period was associated with 28-day mortality in the adjusted logistic regression model (RR 1.029; 95% CI, 1.01 to 1.047; P < 0.001) [Table S3 in Additional data file 1]. Mean heart rates in the highest sixtile (>122 bpm) were associated with a significantly higher 28-day mortality than heart rates in the lowest sixtile (<92 bpm). Again, the mean vasopressor load revealed the strongest association with 28-day mortality.DiscussionThe results of this post hoc analysis confirmed our study hypothesis that MAP levels exceeding 70 mmHg were not associated with 28-day mortality or the occurrence of disease-related events in patients with septic shock.
In contrast, any increase of MAP over 70 mmHg achieved by an increase of vasopressor dosages appears to be associated with the number of disease-related events and mortality.A limitation Cilengitide of our study is that analysed data were collected more than a decade ago and it can be argued that hemodynamic management of septic shock has changed since then. Specifically, the recent Surviving Sepsis Campaign recommended maintaining a minimum MAP of 65 mmHg as opposed to 70 mmHg in this trial.