The U-shaped impact of mean arterial pressure on 28-day mortality of patients with sepsis: A retrospective cohort study from the MIMIC-IV database (Preprint)

BACKGROUND Sepsis is a major cause of high mortality and morbidity in intensive care unit. The effect of mean arterial pressure (MAP) on 28-day mortality in patients with sepsis is controversial. OBJECTIVE The purpose of this study was to explore the signature of the impact of MAP on 28-day mortality in patients with sepsis using data from a large, multicenter database. METHODS In a retrospective cohort of 35,010 patients with sepsis from the Medical Information Mart for Intensive Care (MIMIC)-IV database, the independent effects of MAP on 28-day mortality were investigated using binary logistic regression and two-piecewise linear model, in which MAP was used as exposure and 28-day death as outcome variables. RESULTS A total of 34,981 patients with sepsis were included in the final analysis, of whom 5,691 (16.27%) died during the 28-day hospital stay. The Generalized additive model (GAM) and smoothed curve fitting found a U-shaped relationship between MAP and 28-day mortality in these patients. The recursive algorithm to calculate the lower and upper inflection points was 70 and 82 mmHg, respectively. When MAP was lower than 70 mmHg, it was negatively associated with 28-day mortality (OR: 0.93; 95% CI: to 0.92-0.94, P < 0.0001); however, once the MAP exceeded 82 mmHg, the negative association was replaced by a positive relationship between MAP and 28-day mortality of patients (OR:1.01; 95%CI:1.01 to 1.02, P = 0.0021). CONCLUSIONS MAP values lower than 70mmHg and higher than 82mmHg have adverse associations with 28-day mortality in patients with sepsis, implying that maintaining the MAP within the two might be beneficial to the prognosis of patients with sepsis. CLINICALTRIAL None,the data is publicly available