Significance Of Blood Pressure Variability In Patients With Sepsis

Objective:The purpose of this thesis was to study the characteristics of blood pressure variability (BPV) and Sepsis and to investigate changes in Blood pressure and its value on severity of illness in patients with sepsis. We also aim to observe the relationship between BPV and inflammatory factors and also to explore relations and mechanisms between BPV and cytokines in patients with sepsis.Methods:We selected89cases of patients with sepsis in September2011-March2012admitted to Tianjin Medical University General Hospital Emergency Center, recorded general clinical data, vital signs and routine blood test, CRP, renal function, procalcitonin (PCT), electrolytes, blood gas analysis, plasma COR, ACTH and other tests of patients in hospital within24hours. APACHE Ⅱ score was calculated within24hours of admission too. According to the score, patients were divided into two groups namely APACHE Ⅱ score>19group and APACHE Ⅱ score≤19group. After measurement of inflammatory parameters, they were analyzed and sequentially divided into two APACHE Ⅱ score groups. We also evaluated24-hour ambulatory BP monitoring within48hours of admission.24-hours Systolic Blood pressure (24-hours SBP),24-hour Diastolic Blood pressure (24-hours DBP), Systolic Blood Pressure Viability (SBPV). Diastolic Blood Pressure Viability (DBPV),Pulse Pressure (PP) and Dipper percentage were abstracted from the reports further analyzed into these two groups. Spearman correlation coefficients were used to examine the strengths of relationships between BPV and inflammatory markers as well as APACHE Ⅱ score. According to prognosis, patients were divided into survival and non-survival groups. Logistic regression analysis were performed to analysis the risk factors affecting prognosis. Receiver operating characteristic (ROC) curve and calculation of the area under the curve analysis was done to determine the prognosis of patients. All these parameters were analyzed using SPSS version17.0(SPSS Inc.,). A value of p<0.05was considered significantResults:1. In septic patients with APACHE Ⅱ score>19group, the values of SBPV, DBPV, non-dipper percentage. COR, LAC, PLT and GLU while comparing with APACHE Ⅱ score<19group were significantly higher (P<0.05), whereas, values of PCT, WBC,Cr, PaO2,CRP,ACTH and TNF-a were not statically significant(P>0.05).2. Correlation analysis showed that APACHE Ⅱ scores correlated significantly with SBPV and DBPV.(P value<0.01, r=0.732and p value<0.01, r=0.762). SBPV and DBPV correlated with COR (p value=0.018and r=0.318; p value=0.008and r=0.353respectively).However, SBPV and DBPV showed no correlation with TNF-a、IL-10、PC(P>0.05).3. On logistic regression analysis of SBPV, DBPV, APACHE Ⅱ score and LAC were used to predict prognosis in terms of survival and non survival. ROC showed that DBPV was a better predictor of survival rate with an AUC value of0.890. Whereas AUC of SBPV, APACHE II score, LAC was0.746,0.831and0.915respectivelyConclusion:1. The values of SBPV, DBPV and non-dipper percentage are higher in patients with sepsis.2. DBPV and SBPV can be used to predictor of survival rate in sepsis patients.3. In patients with sepsis, DBPV and SBPV has no associations with change in inflammatory bio-markers...