Journal of critical care · 2026
Prognostic performance of the ratio of mean arterial pressure to norepinephrine equivalent dose in critically ill hypotensive patients: A single-center retrospective cohort study.
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Kotani Yuki, Karumai Toshiyuki, Yamamoto Ryohei, Hayashi Yoshiro
Аннотация
BACKGROUND: The ratio of mean arterial pressure (MAP) to norepinephrine equivalent dose (NED) may better quantify the degree of hemodynamic instability by incorporating both patient response and intervention intensity.
OBJECTIVES: To evaluate the prognostic performance of the MAP/NED ratio for mortality.
METHODS: This single-center retrospective cohort study consecutively included adult critically ill hypotensive patients who received norepinephrine infusion of at least 5 μg/min (in base formulation) within the first 24 h of intensive care unit (ICU) stay. The exposure of interest was the lowest MAP/NED ratio during the initial 24 h. The primary outcome was hospital mortality. We assessed the predictive validity of the lowest MAP/NED ratio for hospital mortality using logistic regression and area under the receiver operating characteristic curve (AUC). We compared the AUC of the lowest MAP/NED ratio with those of the lowest MAP and highest NED.
RESULTS: Among 937 patients, hospital mortality was 29%. After adjustment for clinically relevant covariates, the lowest MAP/NED ratio remained independently associated with hospital mortality (adjusted odds ratio for the highest vs. lowest tertile, 0.60; 95% CI, 0.38-0.92). The AUC of the lowest MAP/NED ratio was 0.625, which was superior to that of the lowest MAP (0.562) and comparable to that of the highest NED (0.625).
CONCLUSIONS: In adult patients receiving vasopressor infusion, the lowest MAP/NED ratio within 24 h of ICU admission was independently associated with hospital mortality. Its prognostic discrimination was slightly higher than that of the lowest MAP value and comparable to that of the highest NED.
OBJECTIVES: To evaluate the prognostic performance of the MAP/NED ratio for mortality.
METHODS: This single-center retrospective cohort study consecutively included adult critically ill hypotensive patients who received norepinephrine infusion of at least 5 μg/min (in base formulation) within the first 24 h of intensive care unit (ICU) stay. The exposure of interest was the lowest MAP/NED ratio during the initial 24 h. The primary outcome was hospital mortality. We assessed the predictive validity of the lowest MAP/NED ratio for hospital mortality using logistic regression and area under the receiver operating characteristic curve (AUC). We compared the AUC of the lowest MAP/NED ratio with those of the lowest MAP and highest NED.
RESULTS: Among 937 patients, hospital mortality was 29%. After adjustment for clinically relevant covariates, the lowest MAP/NED ratio remained independently associated with hospital mortality (adjusted odds ratio for the highest vs. lowest tertile, 0.60; 95% CI, 0.38-0.92). The AUC of the lowest MAP/NED ratio was 0.625, which was superior to that of the lowest MAP (0.562) and comparable to that of the highest NED (0.625).
CONCLUSIONS: In adult patients receiving vasopressor infusion, the lowest MAP/NED ratio within 24 h of ICU admission was independently associated with hospital mortality. Its prognostic discrimination was slightly higher than that of the lowest MAP value and comparable to that of the highest NED.