Association Between Blood Pressure During Vasopressor Weaning and Hospital Survival: What are the Optimal Targets of Vasopressor Support?

Zichen Wang, Luming Zhang, Wen Wa, Hao Wang, Haiyan Yin, Jun Lyu



Objective: Vasopressors are one of the most common treatments for severe hypotension or shock and are often used for patients in intensive care units (ICUs). However, few studies have investigated the appropriate targets for vasopressor weaning. This study aimed to determine the effect of blood pressure during vasopressor weaning on in-hospital mortality risk.

Method: This retrospective study was based on patients using vasopressors from the Medical Information Mart for Intensive Care IV database. The outcome was in-hospital mortality. Restricted cubic splines (RCSs) were used to study the relationship between blood pressures during vasopressor weaning (systolic [WSBP], diastolic [WDBP], and mean arterial [WMAP]) and all-cause mortality in patients. The patients were independently divided into different cohorts according to the two truncation methods generated by WSBP, WDBP, and WMAP, and sensitivity analysis was performed by multivariable Cox proportional hazard regression.

Result: The analysis involved 8,294 ICU patients treated with vasopressors. The RCS result found that WSBP, WDBP and WMAP had “U-shaped” non-linear relationships with in-hospital mortality. Based on the intersection points of the WSBP, WDBP and WMAP median reference values, patients were divided the following three groups of cohorts: <110, 110–150, and >150 mmHg; <60, 60–85, and >85 mmHg; and <75, 75–110, >110 mmHg; respectively. Compared with the lower blood pressure cohorts, the sensitivity analysis results indicated that when WSBP, WDBP, and WMAP were within 110–150, 60–85, and 75–110 mmHg, respectively, the in-hospital mortality risks were lowest, with hazard ratios (95% confidence intervals) of 0.59 (0.52, 0.66), 0.62 (0.55, 0.70), and 0.64 (0.57, 0.72), respectively. The results of the subgroup analysis indicated that the blood pressure during weaning interacted with cerebrovascular and chronic pulmonary diseases. The RCS results indicated differences in the dose–response relationship between weaning blood pressure and in-hospital mortality of patients with different diagnoses.

Conclusion: Higher blood pressure during vasopressor weaning was associated with better survival rates for ICU patients, and the optimal target WSBP, WDBP, and WMAP values were 110–150, 60–85, and 75–110 mmHg, respectively. When treating patients with different diagnoses, the optimal blood pressure may shift, requiring a comprehensive analysis of treatment strategy decision-making.

Keywords: ICU patients; Vasopressor weaning; Blood pressure management

Palabras Clave

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