(1623) Association of MAP Variability and 30-Day Mortality in Adults With Septic Shock

Introduction: Volume resuscitation and vasopressors to keep mean arterial pressure (MAP) above 65 is the standard of care in septic shock. The impact of blood pressure variability (BPV) above and below MAP of 65 is less defined. The aim of this study is to examine the association between MAP variability and 30-day mortality during the first twenty-four hours in patients with septic shock.

Methods: This was a multicenter single health-system retrospective study that included adults with septic shock who were admitted between April 1, 2014 and August 30, 2022. We excluded patients who did not require vasopressors, died within twenty-four hours of admission, had less than 23 hours of hemodynamic recording after vasopressors initiation. A prespecified secondary analysis excluded patients who had had 3 consecutive MAP readings below 40 mmHg or above 90 mmHg. We used logistic regression with 30-day mortality as an outcome and each the following variables as a measure of MAP variability: average real variability (ARV) of MAP, Generalized ARV of MAP, Squared ARV of MAP, coefficient of variation (CV) of MAP, Average absolute rate of MAP change, and root mean squared rate of MAP change. Restricted cubic splines with 3 knots were used to capture nonlinearity.

Results: A total of 3,206 patients were included in the primary analysis. The mean age was 66 years and 1,654 (51.6%) were males. The most common co-morbidities were chronic heart failure (46.96%), Diabetes mellitus (46.6%), coronary artery disease (42.5%), and chronic kidney disease (41.3%). The median SOFA score was 8 (Interquartile range: 5 – 11). ARV – MAP, squared ARV- MAP, average absolute rate of MAP change, and root mean squared rate of MAP change were associated with 30-day mortality (P < 0.0001). Generalized ARV- MAP and CV were also associated with 30-day morality (p =0.002 and p= 0.025, respectively). The prespecified secondary analysis results (n= 2,239) were similar to the primary analysis, however, there were no association between generalized ARV – MAP or CV and 30-day mortality (p=0.27 and p=0.113, respectively).

Conclusions: There was significant association between MAP variability and 30-day mortality in adult patients with septic shock.