Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Oct 21;25(1):512.
doi: 10.1186/s12871-025-03382-7.

Impact of diastolic blood pressure time under range on mortality and acute kidney injury in septic patients: a retrospective cohort study

Jian Zhao #  1 , Si Tong Lin #  1 , Ai Hua Qin #  2 , Cheng Rui Zhou #  1 , Xiang Dong Huang  3 , Hua Guo Chen  1 , Shu Qin Zhou  4 , Hu Peng  5 , Yuan Zhuo Chen  6
Affiliations

Impact of diastolic blood pressure time under range on mortality and acute kidney injury in septic patients: a retrospective cohort study

Jian Zhao et al. BMC Anesthesiol. .

Abstract

Background: Current guidelines for sepsis management focus on maintaining mean arterial pressure, while the impact of low diastolic blood pressure (DBP) exposure remains unclear. This study investigated whether the time under range of DBP (DBP-TUR) is associated with clinical outcomes in septic patients who achieved conventional blood pressure targets.

Methods: In this retrospective cohort study using the MIMIC-IV database, we included 12,114 adult patients with sepsis. DBP-TUR was defined as the proportion of time with DBP < 50 mmHg while maintaining systolic blood pressure > 90 mmHg or mean arterial pressure > 65 mmHg during the first 48 h after ICU admission. Primary outcome was 28-day mortality, and secondary outcome was acute kidney injury (AKI).

Results: Among the cohort, 6,192 patients (51.1%) experienced low DBP exposure. Patients were stratified into quartiles based on DBP-TUR (Q1: ≤5%, Q2: 5-15%, Q3: 15-50%, Q4: >50%). After adjusting for confounders, compared with Q1, both Q3 (OR:1.25, 95% CI:1.02-1.54) and Q4 (OR:1.27, 95% CI:1.02-1.57) showed significantly higher 28-day mortality. Similarly, AKI risk increased in Q3 (OR:1.47, 95% CI:1.14-1.91) and Q4 (OR:1.60, 95% CI:1.20-2.14). DBP-TUR demonstrated moderate predictive value for both mortality (AUC:0.73) and AKI (AUC:0.71).

Conclusion: Low DBP exposure, despite achieving conventional blood pressure targets, was independently associated with increased mortality and AKI risk in septic patients. Monitoring DBP-TUR might provide additional value in hemodynamic management of sepsis.

Keywords: Acute kidney injury; Diastolic blood pressure; Mortality; Sepsis; Time under range.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The MIMIC-IV database was approved by the Institutional Review Boards of Massachusetts Institute of Technology (Cambridge, MA) and Beth Israel Deaconess Medical Center (Boston, MA). Informed consent was obtained for the original data collection. The requirement for individual patient consent was waived as the project did not impact clinical care and all protected health information was de-identified. Not applicable. This study utilized the publicly available de-identified MIMIC-IV database which received ethical approval including waiver of informed consent by the Institutional Review Boards of Beth Israel Deaconess Medical Center (BIDMC) and the Massachusetts Institute of Technology (MIT). Consent for publication: Not applicable. This study utilized the publicly available de-identified MIMIC-IV database. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Distribution of Time Under Range for Diastolic Blood Pressure in Septic Patients
Fig. 2
Fig. 2
Kaplan-Meier Survival Curves Stratified by DBP-TUR Quartiles
Fig. 3
Fig. 3
Dose-Response Relationship between DBP-TUR and 28-day Mortality
Fig. 4
Fig. 4
.ROC Curve for DBP-TUR in Predicting 28-day Mortality
Fig. 5
Fig. 5
ROC Curves for DBP-TUR in Predicting AKI
Fig. 6
Fig. 6
Norepinephrine Analysis Across DBP-TUR Quartiles
See this image and copyright information in PMC

References

    1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315:801. 10.1001/jama.2016.0287. - PMC - PubMed
    1. Hotchkiss RS, Monneret G, Payen D. Sepsis-induced immunosuppression: from cellular dysfunctions to immunotherapy. Nat Rev Immunol. 2013;13:862–74. 10.1038/nri3552. - PMC - PubMed
    1. Vincent J-L, Opal SM, Marshall JC, Tracey KJ. Sepsis definitions: time for change. Lancet. 2013;381:774–5. 10.1016/s0140-6736(12)61815-7. - PMC - PubMed
    1. Gotts JE, Matthay MA. Sepsis: pathophysiology and clinical management. BMJ. 2016;353:i1585. 10.1136/bmj.i1585. - PubMed
    1. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43:304–77. 10.1007/s00134-017-4683-6. - PubMed

LinkOut - more resources