AUTHOR=Shao Ying , Hu Jinzhu 

TITLE=U-Shaped Association Between Blood Pressure and Mortality Risk in ICU Patients With Atrial Fibrillation: The MIMIC-III Database

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.866260

DOI=10.3389/fcvm.2022.866260

ISSN=2297-055X

ABSTRACT=Background: Existing evidence on the association between blood pressure (BP) and mortality risk in intensive care unit (ICU) patients with atrial fibrillation (AF) is scarce.
Aim: This study aimed to assess the associations between BP and risks of in-hospital and all-cause mortality in ICU patients with AF.
Methods: A total of 2345 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.
Results: Smooth 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, 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; DBP, OR=0.970, 95% CI 0.957-0.983, p<0.001).
Conclusions: We 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..