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Zhang C, Liang W, Su W, Chen Y, Guo T, Hu K, Ning M, Liu Y. Correlation between blood pressure and mortality in older critically ill patients: Insights from a large intensive care unit database. Exp Gerontol 2024; 196:112573. [PMID: 39236872 DOI: 10.1016/j.exger.2024.112573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 08/22/2024] [Accepted: 09/02/2024] [Indexed: 09/07/2024]
Abstract
OBJECTIVES The study aimed to investigate the relationship between blood pressure (BP) levels and mortality among critically ill older adults in the intensive care unit (ICU), establish optimal BP target for this population, and assess the mediating effect of severe malnutrition on BP-related mortality. METHODS Data were extracted from the Medical Information Mart for Intensive Care IV version 2.2 database, focusing on critically ill patients aged 80 years and older. The analysis included various BP parameters, such as systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP). RESULTS The study cohort comprised 14,660 critically ill patients, of whom 1558 (10.6 %) experienced ICU mortality and 2493 (17.0 %) experienced in-hospital mortality. Lower BP levels (SBP ≤ 112 mmHg; DBP ≤ 53 mmHg; MAP ≤65 mmHg), were associated with an increased risk of both ICU and in-hospital mortality. Notably, only reduced SBP levels were linked to a higher risk of 1-year mortality, with an adjusted hazard ratio 1.13 (95 % confidence interval 1.05 to 1.23). Additionally, severe malnutrition was identified as a mediator in the relationship between low BP levels and ICU mortality, with BP levels positively correlated with prognostic nutritional indexes. CONCLUSION Among critically ill older adults, lower BP levels are significantly associated with higher risks of ICU and in-hospital mortality, while reduced SBP levels are linked to 1-year mortality. These findings emphasize the importance of assessing nutritional status in older ICU patients with low BP levels to potentially mitigate mortality risk.
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Affiliation(s)
- Chong Zhang
- The Third Central Clinical College of Tianjin Medical University, Tianjin 300170, China; Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin 300170, China; Artificial Cell Engineering Technology Research Center, Tianjin 300170, China; Tianjin Institute of Hepatobiliary Disease, Tianjin 300170, China; Department of Heart Center, the Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin 300170, China
| | - Weiru Liang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - Wei Su
- The Third Central Clinical College of Tianjin Medical University, Tianjin 300170, China; Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin 300170, China; Artificial Cell Engineering Technology Research Center, Tianjin 300170, China; Tianjin Institute of Hepatobiliary Disease, Tianjin 300170, China; Department of Heart Center, the Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin 300170, China
| | - Yi Chen
- The Third Central Clinical College of Tianjin Medical University, Tianjin 300170, China; Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin 300170, China; Artificial Cell Engineering Technology Research Center, Tianjin 300170, China; Tianjin Institute of Hepatobiliary Disease, Tianjin 300170, China; Department of Heart Center, the Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin 300170, China
| | - Tingting Guo
- The Third Central Clinical College of Tianjin Medical University, Tianjin 300170, China; Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin 300170, China; Artificial Cell Engineering Technology Research Center, Tianjin 300170, China; Tianjin Institute of Hepatobiliary Disease, Tianjin 300170, China; Department of Heart Center, the Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin 300170, China
| | - Kun Hu
- The Third Central Clinical College of Tianjin Medical University, Tianjin 300170, China; Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin 300170, China; Artificial Cell Engineering Technology Research Center, Tianjin 300170, China; Tianjin Institute of Hepatobiliary Disease, Tianjin 300170, China; Department of Heart Center, the Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin 300170, China
| | - Meng Ning
- The Third Central Clinical College of Tianjin Medical University, Tianjin 300170, China; Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin 300170, China; Artificial Cell Engineering Technology Research Center, Tianjin 300170, China; Tianjin Institute of Hepatobiliary Disease, Tianjin 300170, China; Department of Heart Center, the Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin 300170, China
| | - Yingwu Liu
- The Third Central Clinical College of Tianjin Medical University, Tianjin 300170, China; Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin 300170, China; Artificial Cell Engineering Technology Research Center, Tianjin 300170, China; Tianjin Institute of Hepatobiliary Disease, Tianjin 300170, China; Department of Heart Center, the Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin 300170, China.
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Schuurmans J, van Rossem BTB, Rellum SR, Tol JTM, Kurucz VC, van Mourik N, van der Ven WH, Veelo DP, Schenk J, Vlaar APJ. Hypotension during intensive care stay and mortality and morbidity: a systematic review and meta-analysis. Intensive Care Med 2024; 50:516-525. [PMID: 38252288 PMCID: PMC11018652 DOI: 10.1007/s00134-023-07304-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/07/2023] [Indexed: 01/23/2024]
Abstract
PURPOSE The aim of this study is to provide a summary of the existing literature on the association between hypotension during intensive care unit (ICU) stay and mortality and morbidity, and to assess whether there is an exposure-severity relationship between hypotension exposure and patient outcomes. METHODS CENTRAL, Embase, and PubMed were searched up to October 2022 for articles that reported an association between hypotension during ICU stay and at least one of the 11 predefined outcomes. Two independent reviewers extracted the data and assessed the risk of bias. Results were gathered in a summary table and studies designed to investigate the hypotension-outcome relationship were included in the meta-analyses. RESULTS A total of 122 studies (176,329 patients) were included, with the number of studies varying per outcome between 0 and 82. The majority of articles reported associations in favor of 'no hypotension' for the outcomes mortality and acute kidney injury (AKI), and the strength of the association was related to the severity of hypotension in the majority of studies. Using meta-analysis, a significant association was found between hypotension and mortality (odds ratio: 1.45; 95% confidence interval (CI) 1.12-1.88; based on 13 studies and 34,829 patients), but not for AKI. CONCLUSION Exposure to hypotension during ICU stay was associated with increased mortality and AKI in the majority of included studies, and associations for both outcomes increased with increasing hypotension severity. The meta-analysis reinforced the descriptive findings regarding mortality but did not yield similar support for AKI.
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Affiliation(s)
- Jaap Schuurmans
- Amsterdam UMC location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Intensive Care, Meibergdreef 9, Amsterdam, The Netherlands
| | - Benthe T B van Rossem
- Amsterdam UMC location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Santino R Rellum
- Amsterdam UMC location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Intensive Care, Meibergdreef 9, Amsterdam, The Netherlands
| | - Johan T M Tol
- Amsterdam UMC location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Vincent C Kurucz
- Amsterdam UMC location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Niels van Mourik
- Amsterdam UMC location University of Amsterdam, Intensive Care, Meibergdreef 9, Amsterdam, The Netherlands
| | - Ward H van der Ven
- Amsterdam UMC location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Denise P Veelo
- Amsterdam UMC location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Jimmy Schenk
- Amsterdam UMC location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Intensive Care, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Amsterdam Public Health, Meibergdreef 9, Amsterdam, The Netherlands
| | - Alexander P J Vlaar
- Amsterdam UMC location University of Amsterdam, Intensive Care, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Laboratory of Experimental Intensive Care and Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands
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Schuurmans J, Veelo DP, Vlaar APJ, Schenk J. Heterogeneity in a meta-analysis: randomized controlled trials versus observational studies. Author's reply. Intensive Care Med 2024; 50:483-484. [PMID: 38421386 DOI: 10.1007/s00134-024-07367-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Jaap Schuurmans
- Amsterdam UMC location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Intensive Care, Meibergdreef 9, Amsterdam, The Netherlands
| | - Denise P Veelo
- Amsterdam UMC location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Alexander P J Vlaar
- Amsterdam UMC location University of Amsterdam, Intensive Care, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Laboratory of Experimental Intensive Care and Anesthesiology, Meibergdreef 9, Amsterdam, Netherlands
| | - Jimmy Schenk
- Amsterdam UMC location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Intensive Care, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Amsterdam Public Health, Meibergdreef 9, Amsterdam, The Netherlands
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Xing Z, Cai L, Wu Y, Shen P, Fu X, Xu Y, Wang J. Development and validation of a nomogram for predicting in-hospital mortality of patients with cervical spine fractures without spinal cord injury. Eur J Med Res 2024; 29:80. [PMID: 38287435 PMCID: PMC10823604 DOI: 10.1186/s40001-024-01655-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/10/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND The incidence of cervical spine fractures is increasing every day, causing a huge burden on society. This study aimed to develop and verify a nomogram to predict the in-hospital mortality of patients with cervical spine fractures without spinal cord injury. This could help clinicians understand the clinical outcome of such patients at an early stage and make appropriate decisions to improve their prognosis. METHODS This study included 394 patients with cervical spine fractures from the Medical Information Mart for Intensive Care III database, and 40 clinical indicators of each patient on the first day of admission to the intensive care unit were collected. The independent risk factors were screened using the Least Absolute Shrinkage and Selection Operator regression analysis method, a multi-factor logistic regression model was established, nomograms were developed, and internal validation was performed. A receiver operating characteristic (ROC) curve was drawn, and the area under the ROC curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were calculated to evaluate the discrimination of the model. Moreover, the consistency between the actual probability and predicted probability was reflected using the calibration curve and Hosmer-Lemeshow (HL) test. A decision curve analysis (DCA) was performed, and the nomogram was compared with the scoring system commonly used in clinical practice to evaluate the clinical net benefit. RESULTS The nomogram indicators included the systolic blood pressure, oxygen saturation, respiratory rate, bicarbonate, and simplified acute physiology score (SAPS) II. The results showed that our model had satisfactory predictive ability, with an AUC of 0.907 (95% confidence interval [CI] = 0.853-0.961) and 0.856 (95% CI = 0.746-0.967) in the training set and validation set, respectively. Compared with the SAPS-II system, the NRI values of the training and validation sets of our model were 0.543 (95% CI = 0.147-0.940) and 0.784 (95% CI = 0.282-1.286), respectively. The IDI values of the training and validation sets were 0.064 (95% CI = 0.004-0.123; P = 0.037) and 0.103 (95% CI = 0.002-0.203; P = 0.046), respectively. The calibration plot and HL test results confirmed that our model prediction results showed good agreement with the actual results, where the HL test values of the training and validation sets were P = 0.8 and P = 0.95, respectively. The DCA curve revealed that our model had better clinical net benefit than the SAPS-II system. CONCLUSION We explored the in-hospital mortality of patients with cervical spine fractures without spinal cord injury and constructed a nomogram to predict their prognosis. This could help doctors assess the patient's status and implement interventions to improve prognosis accordingly.
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Affiliation(s)
- Zhibin Xing
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Lingli Cai
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yuxuan Wu
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Pengfei Shen
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xiaochen Fu
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yiwen Xu
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jing Wang
- The First Affiliated Hospital of Jinan University, Guangzhou, China.
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Liang Z, Yue S, Zhong J, Wu J, Chen C. Associations of systolic blood pressure and in-hospital mortality in critically ill patients with acute kidney injury. Int Urol Nephrol 2023:10.1007/s11255-023-03510-7. [PMID: 36840802 DOI: 10.1007/s11255-023-03510-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/06/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE Although systolic blood pressure (SBP) is associated with acute renal injury (AKI), the relationship between baseline SBP and prognosis in critically ill patients with AKI is unclear. We aimed to assess the linearity and profile of the relationship between SBP at intensive care unit (ICU) admission and in-hospital mortality in these patients. METHODS Data of AKI patients in the ICU settings were extracted from the Medical Information Mart for Intensive Care III database. The association between seven SBP categories (< 100, 100-109, 110-119, 120-129, 130-139, 140-149, and ≥ 150 mmHg) and all-cause in-hospital mortality was assessed by Cox proportional hazard models. Restricted cubic spline analysis for the multivariate Cox model was performed to explore the shape of the relationship between SBP and mortality. RESULTS A total of 24,202 patients with AKI were included in this study. A typically U-shaped relationship was found between SBP at admission and in-hospital mortality. Among all SBP categories, the lowest risk of death was observed in patients with SBP around 110-119 mmHg, whereas the highest was noted in patients with extremely low SBP (< 100 mmHg), followed by those with extremely high SBP (≥ 150 mmHg). SBP showed a significant interaction with vasopressor use and AKI stage in relation to the risk of in-hospital mortality. CONCLUSIONS SBP upon admission showed a non-linear association with all-cause in-hospital mortality in critically ill patients with AKI. Patients with low or high SBP show an increased risk of mortality compared to patients with normal SBP.
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Affiliation(s)
- Zheng Liang
- The First Clinical Medical College of Jinan University, Guangzhou, 510632, China.,Department of Vasculocardiology, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China
| | - Suru Yue
- Clinical Research Service Center, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, Guangdong, China
| | - Jianfeng Zhong
- Department of Vasculocardiology, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China
| | - Jiayuan Wu
- Clinical Research Service Center, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, Guangdong, China.
| | - Can Chen
- The First Clinical Medical College of Jinan University, Guangzhou, 510632, China.
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Zhao X, Feng Q, Wahid A, Wang X, Wen J, Jiang W, Tang X. Sex differences in the association between blood pressure and atrial fibrillation: A case-control study. Front Cardiovasc Med 2022; 9:1061240. [PMID: 36568551 PMCID: PMC9772049 DOI: 10.3389/fcvm.2022.1061240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
Background To examine the association of hypertension (HBP) and its control with atrial fibrillation (AF) and how patient sex affects this association. Materials and methods A case control study of patients admitted to our hospital from 2015 to 2019 was conducted. Patients were divided into subgroups according to their blood pressure (BP) levels and control status, in which odd ratios (OR) by sex for AF was estimated using a logistic regression model and restrictive cubic splines before and after propensity score matching. Results A total of 3,212 patients with AF and 8,307 without AF were investigated. Compared to patients with normal BP, patients with HBP had more AF [OR = 1.75 (1.52-2.02), OR = 2.66 (2.24-3.15), and OR = 4.30 (3.40-5.44) in patients with grade 1, 2, and 3 HBP, respectively]. In HBP patients with grade 3, the OR of AF was much higher in women than in men (OR = 7.15, 95% CI: 4.43-11.50 vs. OR = 2.48, 95% CI: 1.66-3.72). BP over 133.1/79.9 mmHg in men or 127.1/75.1 mmHg in women was positively associated with AF. In patients with HBP, uncontrolled BP was more associated with AF (OR = 3.00, 95% CI: 2.53-3.56), especially in women (OR = 3.09, 95% CI: 2.27-4.19). BP and prevalence of AF correlated with each other positively in patients admitted to a cardiology ward. Lowering BP to 145.1/85.8 mmHg in men or 140.5/82.5 mmHg in women led to less AF. Conclusion There is more significant relationship between HBP and AF in female patients. A lower and individualized BP target may be formulated to prevent AF in women.
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Affiliation(s)
- Xiexiong Zhao
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Qilun Feng
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China,Department of Cardiology, The Affiliated Nanhua Hospital, University of South China, Hengyang, China
| | - Abdul Wahid
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoyan Wang
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Juan Wen
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Weihong Jiang
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiaohong Tang
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China,*Correspondence: Xiaohong Tang,
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Huang S, Luo Y, Liang L, Guo N, Duan X, Zhou Q, Ge L. The baseline and repeated measurements of DBP to assess in-hospital mortality risk among critically ill patients with acute myocardial infarction: A retrospective cohort study. Medicine (Baltimore) 2022; 101:e30980. [PMID: 36221379 PMCID: PMC9543008 DOI: 10.1097/md.0000000000030980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/06/2022] [Indexed: 01/05/2023] Open
Abstract
Changes in diastolic blood pressure (DBP) are common in patients with acute myocardial infarction (AMI). The relationship between the dynamic change of DBP and in-hospital mortality among patients with AMI remains unclear. This study aimed to explore the importance of DBP during disease development among patients with AMI. We performed a retrospective cohort study involving patients from the Medical Information Mart for Intensive Care III database, which included > 40,000 patients admitted to the intensive care unit (ICU). Overall, 3209 adult AMI admissions were identified. We extracted the clinical and laboratory information in the patients with AMI. Cox proportional hazards models were used to evaluate the prognostic values of baseline DBP. We used the generalized additive mixed model (GAMM) to compare trends in DBP over time among survivors and non-survivors, after adjusting for potential confounders. During the ICU stay, 189 patients died (mortality rate, 6.36%). The age of each non-survivor together with the variations in DBP over time from admission to the time of death is of great importance to the scientific community. Cox multivariable regression analysis displayed that after adjusting for confounding factors, ascended baseline DBP was an important hazard factor for hospital deaths (hazard ratio, 1.02; 95% confidence interval, 1.01-1.03; P = .003). Based on GAMM, DBP in the death group was markedly lower than that of the surviving group. Moreover, the difference between the two groups showed an increasing trend within 3 days after ICU admission. After adjusting for various variables, the results were stable. DBP significantly contributed to in-hospital mortality among patients with AMI. There was a nonlinear correlation between baseline DBP and in-hospital mortality among patients with AMI, and the DBP of the non-survivors decreased within the first 3 days after ICU admission. However, the causality cannot be deduced from our data.
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Affiliation(s)
- Sulan Huang
- Cardiovascular Medicine Department, The First People’s Hospital of Changde City, Changde City, Hunan Province, People’s Republic of China
| | - Yanlan Luo
- Cardiovascular Medicine Department, The First People’s Hospital of Changde City, Changde City, Hunan Province, People’s Republic of China
| | - Li Liang
- Cardiovascular Medicine Department, The First People’s Hospital of Changde City, Changde City, Hunan Province, People’s Republic of China
| | - Ning Guo
- Cardiovascular Medicine Department, The First People’s Hospital of Changde City, Changde City, Hunan Province, People’s Republic of China
| | - Xiangjie Duan
- Infectious Disease Department, The First People’s Hospital of Changde, Changde City, Hunan Province, People’s Republic of China
| | - Quan Zhou
- Department of Science and Education Section, The First People’s Hospital of Changde, Changde City, Hunan Province, 415000, People’s Republic of China
| | - Liangqing Ge
- Cardiovascular Medicine Department, The First People’s Hospital of Changde City, Changde City, Hunan Province, People’s Republic of China
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What's New in Shock, October 2021? Shock 2021; 56:479-483. [PMID: 34524265 DOI: 10.1097/shk.0000000000001857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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