Association of 24-h Blood Pressure Pattern With Mortality in ICU Patients: A Multicenter Retrospective Study

Abstract

Blood pressure (BP) is a crucial component of the APACHE II scoring system for assessing the severity of illness in ICU patients, and it plays a pivotal role in predicting patient mortality. Based on fluctuations, the 24-h BP patterns of ICU patients can be categorized into dippers (10% ≤ the fall < 20%), extreme-dippers (fall ≥ 20%), non-dippers (0% ≤ the fall < 10%), and reverse-dippers (fall < 0%). This study aims to investigate whether there are statistically significant differences in ICU mortality, in-hospital mortality, 28-day mortality, and 1-year mortality among the dipper, non-dipper, extreme-dipper, and reverse-dipper groups. We enrolled all adult patients with continuous BP monitoring within 24 h of ICU admission. Using Navicat Premium 16 software, we extracted the first 24-h BP values of 10462 patients from the MIMIC IV v2.2 database. Patients were then classified into the dipper group (n = 1244), non-dipper group (n = 6162), reverse-dipper group (n = 2940), and extreme-dipper group (n = 116). Among ICU patients, the non-dipper pattern group constituted the largest proportion (58.90%), followed by the reverse-dipper pattern group (28.10%). After adjusting for relevant confounding factors, we found that the reverse-dipper group had the strongest correlation with in-hospital mortality (OR: 1.592, p < 0.05), 28-day mortality (OR: 1.607, p < 0.01), 90-day mortality (OR: 1.402, p < 0.01), 180-day mortality (OR: 1.403, p < 0.01), and 1-year mortality (OR: 1.525, p < 0.001), with statistical significance observed for all these associations. In the ICU setting, the non-dipper BP pattern is the most prevalent. However, the reverse-dipper pattern is the most significantly associated with mortality.

Keywords: 24‐h BP patterns; mortality; non‐dipper group; reverse‐dipper group.

FIGURE 1

The Flowchart of participant selection. A total of 10 462 patients were included in the analysis. The patients were divided into four groups: Dipper pattern group (n = 1244), Non‐dipper pattern group (n = 6162), Extreme‐dipper pattern group (n = 116), Reverse‐dipper pattern group (n = 2940).

FIGURE 2

Distribution of four blood pressure waveform curves in ICU patients. The above figure shows the distribution of blood pressure waveform in ICU patients. We can see that non‐dipper pattern group accounts for the highest proportion in ICU, followed by reverse‐dipper pattern group, dipper pattern group, and extreme‐dipper pattern group.

FIGURE 3

Kaplan–Meier survival curve. Kaplan–Meier survival analysis plot for 28‐day, 90‐day, 180‐day, 1‐year survival curve with Dipper pattern group, Non‐dipper pattern group, Extreme‐dipper pattern group, and Reverse‐dipper pattern group. * indicates that p value is less than 0.05; ** indicates that p value is less than 0.01; *** indicates that p value is less than 0.001.