Blood Pressure Response Index and Mortality in Patients With Cardiogenic Shock: A Multicenter Retrospective Cohort Study.

BACKGROUND

The blood pressure response index (BPRI) is an easy, rapid, precise dose-effect index to reflect the cardiovascular response of patients with septic shock. However, the relationship between BPRI and clinical outcomes in patients with cardiogenic shock (CS) has not been elucidated.

METHODS

We extracted the clinical data of patients with CS admitted to the ICU from the MIMIC-IV (v3.1) database and the eICU Collaborative Research Database (eICU-CRD). The predictive ability for in-hospital mortality was evaluated using the receiver operating characteristic curve. The relationship between BPRI and in-hospital mortality was explored utilizing restricted cubic splines, segmented logistic regression, and subgroup analysis. A new prediction model for CS was established and assessed by receiver operating characteristic curves and decision curve analysis.

RESULTS

There were 1456 and 386 patients in the MIMIC-IV and eICU-CRD cohorts, respectively. BPRI had a better area under the receiver operator characteristic curve for predicting in-hospital mortality than sequential organ failure assessment (SOFA) score and BOS, MA2 risk score in both MIMIC-IV and eICU-CRD cohort. We found an L-shaped association between BPRI and in-hospital mortality (P for nonlinear <0.001), with the cutoff values at 2.4 in both cohorts. The newly developed model utilizing BPRI demonstrated a good predictive ability for in-hospital mortality among patients with CS (area under the curve=0.799).

CONCLUSIONS

BPRI is a powerful predictor for in-hospital mortality among patients with CS admitted to the ICU. The application of BPRI can help clinicians achieve early warning of mortality risk and early decision-making, guide the use of vasoactive drugs, and assist the risk stratification.