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Huang YH, Lee TH, Ting CW. Exploring the relationship between admission pulse pressure and clinical features in patients with spontaneous supratentorial intracerebral hemorrhage. Neurosurg Rev 2023; 47:19. [PMID: 38135792 DOI: 10.1007/s10143-023-02256-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 12/24/2023]
Abstract
Elevated pulse pressure is commonly observed in cardiovascular diseases and serves as an independent risk factor and predictor of cardiac mortality. However, the role of pulse pressure in patients with spontaneous intracerebral hemorrhage (ICH) remains uncertain. This study aimed to investigate the association between admission pulse pressure and clinical characteristics, including in-hospital outcomes, in ICH patients. We retrospectively analyzed the data of 292 ICH patients, categorizing them into two groups based on admission wide pulse pressure: > 100 mmHg (n = 60) and ≤ 100 mmHg (n = 232). Clinical characteristics and in-hospital outcomes were compared between the groups, and multivariate logistic regression was performed to identify independent factors. Patients with wide pulse pressure were older, had lower Glasgow Coma Scale, larger intraparenchymal hematomas, more pronounced midline shifts, and higher rates of intraventricular hematoma extension and hydrocephalus. These patients also experienced higher frequencies of craniotomy or craniectomy and longer hospital stays. Multivariate logistic regression revealed that pulse pressure > 100 mmHg was significantly associated with increased in-hospital mortality (odds ratio 4.31, 95% confidence interval 1.12-16.62, p = 0.03), but not with a modified Rankin Scale score of 4-6. In conclusion, our investigation demonstrates a significant relationship between admission pulse pressure and severe clinical characteristics in ICH patients. Importantly, a wider pulse pressure is linked to heightened in-hospital mortality. These results underscore the necessity for customized strategies to predict patient outcomes in this population. Further research is essential to explore potential therapeutic interventions targeting pulse pressure to improve clinical outcomes for ICH patients.
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Affiliation(s)
- Yu-Hua Huang
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tsung-Han Lee
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chun-Wei Ting
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Lee SH, Kim YJ, Yu GN, Jeon JC, Kim WY. Pulse pressure during the initial resuscitative period in patients with septic shock treated with a protocol-driven resuscitation bundle therapy. Korean J Intern Med 2021; 36:924-931. [PMID: 32811131 PMCID: PMC8273825 DOI: 10.3904/kjim.2020.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/26/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Maintaining a mean arterial pressure (MAP) ≥ 65 mmHg during septic shock should be based on individual circumstances, but specific target is poorly understood. We investigated associations between time-weighted average (TWA) hemodynamic parameters during the initial resuscitative period and 28-day mortality. METHODS Prospectively collected data were obtained from a septic shock patient registry, according to the Sepsis-3 definition, between 2016 and 2018. The TWA systolic blood pressure, diastolic blood pressure, MAP, shock index, and pulse pressure (PP) during the first 6 hours after shock recognition were compared. Multivariable regression analysis was performed to assess associations between these parameters and 28-day mortality. RESULTS Of 340 patients with septic shock, 92 died. Only the median TWA PP differed between the survivors and non-survivors (39.2 mmHg vs. 43.0 mmHg, p = 0.020), whereas the other indexes did not. When PP was divided into quartiles (< 34, 34 to 40, 40 to 48, and > 48 mmHg), the mortality rate was higher in the highest quartile (41.2%). Multivariable logistic analysis revealed that PP (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.012 to 1.622; p = 0.039) and PP of > 48 mmHg (OR, 2.25; 95% CI, 1.272 to 3.981; p = 0.005) were independently associated with 28-day mortality. CONCLUSION PP was significantly associated with 28-day mortality in patients with septic shock and MAP maintained at > 65 mmHg during the first 6 hours. Further studies are warranted to optimize strategies for maintaining PP and MAP at > 65 mmHg during the early resuscitative period.
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Affiliation(s)
- Sang-Hun Lee
- Department of Emergency Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Youn-Jung Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi Na Yu
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Cheon Jeon
- Department of Emergency Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Correspondence to Won Young Kim, M.D. Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-3350 Fax: +82-2-3010-3360 E-mail:
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Feature Engineering for ICU Mortality Prediction Based on Hourly to Bi-Hourly Measurements. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9173525] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mortality prediction for intensive care unit (ICU) patients is a challenging problem that requires extracting discriminative and informative features. This study presents a proof of concept for exploring features that can provide clinical insight. Through a feature engineering approach, it is attempted to improve ICU mortality prediction in field conditions with low frequently measured data (i.e., hourly to bi-hourly). Features are explored by investigating the vital signs measurements of ICU patients, labelled with mortality or survival at discharge. The vital signs of interest in this study are heart and respiration rate, oxygen saturation and blood pressure. The latter comprises systolic, diastolic and mean arterial pressure. In the feature exploration process, it is aimed to extract simple and interpretable features that can provide clinical insight. For this purpose, a classifier is required that maximises the margin between the two classes (i.e., survival and mortality) with minimum tolerance to misclassification errors. Moreover, it preferably has to provide a linear decision surface in the original feature space without mapping to an unlimited dimensionality feature space. Therefore, a linear hard margin support vector machine (SVM) classifier is suggested. The extracted features are grouped in three categories: statistical, dynamic and physiological. Each category plays an important role in enhancing classification error performance. After extracting several features within the three categories, a manual feature fine-tuning is applied to consider only the most efficient features. The final classification, considering mortality as the positive class, resulted in an accuracy of 91.56 % , sensitivity of 90.59 % , precision of 86.52 % and F 1 -score of 88.50 % . The obtained results show that the proposed feature engineering approach and the extracted features are valid to be considered and further enhanced for the mortality prediction purpose. Moreover, the proposed feature engineering approach moved the modelling methodology from black-box modelling to grey-box modelling in combination with the powerful classifier of SVMs.
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Jokh Chaaya DA, de Souza Nogueira L, de Cassia Gengo E Silva Butcher R, Reboreda JZ, Silva Bonfim AK, Padilha KG. Pulse Pressure and Mortality Risk in Critically Ill Patients. AACN Adv Crit Care 2019; 29:118-125. [PMID: 29875108 DOI: 10.4037/aacnacc2018335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Pulse pressure is a hemodynamic variable easily measured in the intensive care unit. OBJECTIVE To investigate whether pulse pressure is an independent risk factor for mortality in intensive care unit patients. METHODS A retrospective cohort study was carried out in Brazil. Data were collected from medical records of patients admitted to intensive care units from September to December 2012. Pulse pressure was calculated from systolic and diastolic blood pressures recorded during the first 24 hours of stay. RESULTS Records of 529 patients (mean [standard deviation] age 55.0 [17.3] years; 54.4% male, 45.6% female) were analyzed. Risk factors for mortality were age, use of vasoactive drugs, nursing workload, and length of stay in the intensive care unit. Analysis indicated that higher minimum pulse pressures were associated with lower mortality risk. CONCLUSION Pulse pressure was not found to be an independent risk factor for mortality in patients who are critically ill.
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Affiliation(s)
- Dúnia Abou Jokh Chaaya
- Dúnia Abou Jokh Chaaya is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Lilia de Souza Nogueira is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, 05403-000, São Paulo, SP, Brazil . Rita de Cassia Gengo e Silva Butcher is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil. Jéssica Zamora Reboreda is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Ane Karoline Silva Bonfim is a PhD student, adult health nursing, School of Nursing, University of São Paulo, Brazil. Katia Grillo Padilha is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil
| | - Lilia de Souza Nogueira
- Dúnia Abou Jokh Chaaya is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Lilia de Souza Nogueira is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, 05403-000, São Paulo, SP, Brazil . Rita de Cassia Gengo e Silva Butcher is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil. Jéssica Zamora Reboreda is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Ane Karoline Silva Bonfim is a PhD student, adult health nursing, School of Nursing, University of São Paulo, Brazil. Katia Grillo Padilha is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil
| | - Rita de Cassia Gengo E Silva Butcher
- Dúnia Abou Jokh Chaaya is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Lilia de Souza Nogueira is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, 05403-000, São Paulo, SP, Brazil . Rita de Cassia Gengo e Silva Butcher is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil. Jéssica Zamora Reboreda is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Ane Karoline Silva Bonfim is a PhD student, adult health nursing, School of Nursing, University of São Paulo, Brazil. Katia Grillo Padilha is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil
| | - Jéssica Zamora Reboreda
- Dúnia Abou Jokh Chaaya is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Lilia de Souza Nogueira is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, 05403-000, São Paulo, SP, Brazil . Rita de Cassia Gengo e Silva Butcher is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil. Jéssica Zamora Reboreda is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Ane Karoline Silva Bonfim is a PhD student, adult health nursing, School of Nursing, University of São Paulo, Brazil. Katia Grillo Padilha is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil
| | - Ane Karoline Silva Bonfim
- Dúnia Abou Jokh Chaaya is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Lilia de Souza Nogueira is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, 05403-000, São Paulo, SP, Brazil . Rita de Cassia Gengo e Silva Butcher is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil. Jéssica Zamora Reboreda is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Ane Karoline Silva Bonfim is a PhD student, adult health nursing, School of Nursing, University of São Paulo, Brazil. Katia Grillo Padilha is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil
| | - Katia Grillo Padilha
- Dúnia Abou Jokh Chaaya is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Lilia de Souza Nogueira is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, 05403-000, São Paulo, SP, Brazil . Rita de Cassia Gengo e Silva Butcher is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil. Jéssica Zamora Reboreda is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Ane Karoline Silva Bonfim is a PhD student, adult health nursing, School of Nursing, University of São Paulo, Brazil. Katia Grillo Padilha is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil
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Nandi M, Venton J, Aston PJ. A novel method to quantify arterial pulse waveform morphology: attractor reconstruction for physiologists and clinicians. Physiol Meas 2018; 39:104008. [PMID: 30256216 PMCID: PMC6372136 DOI: 10.1088/1361-6579/aae46a] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Current arterial pulse monitoring systems capture data at high frequencies (100-1000 Hz). However, they typically report averaged or low frequency summary data such as heart rate and systolic, mean and diastolic blood pressure. In doing so, a potential wealth of information contained in the high-fidelity waveform data is discarded, data which has long been known to contain useful information on cardiovascular performance. Here we summarise a new mathematical method, attractor reconstruction, which enables the quantification of arterial waveform shape and variability in real-time. The method can handle long streams of non-stationary data and does not require preprocessing of the raw physiological data by the end user. Whilst the detailed mathematical proofs have been described elsewhere (Aston et al 2008 Physiol. Meas. 39), the authors were motivated to write a summary of the method and its potential utility for biomedical researchers, physiologists and clinician readers. Here we illustrate how this new method may supplement and potentially enhance the sensitivity of detecting cardiovascular disturbances, to aid with biomedical research and clinical decision making.
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Affiliation(s)
- Manasi Nandi
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, Franklin Wilkins Building, 150 Stamford Street, London SE1 9NH, United Kingdom. School of Cardiovascular Medicine and Sciences, Faculty of Life Sciences and Medicine, King's College London, Franklin Wilkins Building, 150 Stamford Street, London SE1 9NH, United Kingdom
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Chang JJ, Khorchid Y, Dillard K, Kerro A, Burgess LG, Cherkassky G, Goyal N, Chapple K, Alexandrov AW, Buechner D, Alexandrov AV, Tsivgoulis G. Elevated Pulse Pressure Levels Are Associated With Increased In-Hospital Mortality in Acute Spontaneous Intracerebral Hemorrhage. Am J Hypertens 2017; 30:719-727. [PMID: 28430838 DOI: 10.1093/ajh/hpx025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 01/31/2017] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Clinical outcome after intracerebral hemorrhage (ICH) remains poor. Definitive phase-3 trials in ICH have failed to demonstrate improved outcomes with intensive systolic blood pressure (SBP) lowering. We sought to determine whether other BP parameters-diastolic BP (DBP), pulse pressure (PP), and mean arterial pressure (MAP)-showed an association with clinical outcome in ICH. METHODS We retrospectively analyzed a prospective cohort of 672 patients with spontaneous ICH and documented demographic characteristics, stroke severity, and neuroimaging parameters. Consecutive hourly BP recordings allowed for computation of SBP, DBP, PP, and MAP. Threshold BP values that transitioned patients from survival to death were determined from ROC curves. Using in-hospital mortality as outcome, BP parameters were evaluated with multivariable logistic regression analysis. RESULTS Patients who died during hospitalization had higher mean PP compared to survivors (68.5 ± 16.4 mm Hg vs. 65.4 ± 12.4 mm Hg; P = 0.032). The following admission variables were associated with significantly higher in-hospital mortality (P < 0.001): poorer admission clinical condition, intraventricular hemorrhage, and increased admission normalized hematoma volume. ROC analysis showed that mean PP dichotomized at 72.17 mm Hg, provided a transition point that maximized sensitivity and specific for mortality. The association of this increased dichotomized PP with higher in-hospital mortality was maintained in multivariable logistic regression analysis (odds ratio, 3.0; 95% confidence interval, 1.7-5.3; P < 0.001) adjusting for potential confounders. CONCLUSION Widened PP may be an independent predictor for higher mortality in ICH. This association requires further study.
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Affiliation(s)
- Jason J Chang
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Yasser Khorchid
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kira Dillard
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Ali Kerro
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Lucia Goodwin Burgess
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Georgy Cherkassky
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Nitin Goyal
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kristina Chapple
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Anne W Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Australian Catholic University, Sidney, Australia
| | - David Buechner
- Department of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Andrei V Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Georgios Tsivgoulis
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, "Attikon University Hospital", Athens, Greece
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