Journal Article

Low diastolic blood pressure and adverse outcomes in inpatients with acute exacerbation of chronic obstructive pulmonary disease: A multicenter cohort study

Liu, Yu, Zhou, Chen, Zhang, Jianchu, Liu, Liang, Yi, Mengqiu, Li, Xianhua, Luo, Yuanming, Ge, Huiqing, Peng, Lige, Cheng, Lina, Liu, Huiguo, Zhou, Haixia, Yi, Qun, Zhang, Jiarui, Aili, Adila, Pu, Jiaqi, Pan, Pinhua, Wei, Hailong

2023

Overview

Although intensively studied in patients with cardiovascular diseases (CVDs), the prognostic value of diastolic blood pressure (DBP) has little been elucidated in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This study aimed to reveal the prognostic value of DBP in AECOPD patients. Inpatients with AECOPD were prospectively enrolled from 10 medical centers in China between September 2017 and July 2021. DBP was measured on admission. The primary outcome was all-cause in-hospital mortality; invasive mechanical ventilation and intensive care unit (ICU) admission were secondary outcomes. Least absolute shrinkage and selection operator (LASSO) and multivariable Cox regressions were used to identify independent prognostic factors and calculate the hazard ratio (HR) and 95% confidence interval (CI) for adverse outcomes. Among 13,633 included patients with AECOPD, 197 (1.45%) died during their hospital stay. Multivariable Cox regression analysis showed that low DBP on admission (<70 mmHg) was associated with increased risk of in-hospital mortality (HR = 2.16, 95% CI: 1.53-3.05, Z = 4.37, P <0.01), invasive mechanical ventilation (HR = 1.65, 95% CI: 1.32-2.05, Z = 19.67, P <0.01), and ICU admission (HR = 1.45, 95% CI: 1.24-1.69, Z = 22.08, P <0.01) in the overall cohort. Similar findings were observed in subgroups with or without CVDs, except for invasive mechanical ventilation in the subgroup with CVDs. When DBP was further categorized in 5-mmHg increments from <50 mmHg to ≥100 mmHg, and 75 to <80 mmHg was taken as reference, HRs for in-hospital mortality increased almost linearly with decreased DBP in the overall cohort and subgroups of patients with CVDs; higher DBP was not associated with the risk of in-hospital mortality. Low on-admission DBP, particularly <70 mmHg, was associated with an increased risk of adverse outcomes among inpatients with AECOPD, with or without CVDs, which may serve as a convenient predictor of poor prognosis in these patients. Chinese Clinical Trail Registry, No. ChiCTR2100044625.

• Publisher: Lippincott Williams & Wilkins,Lippincott Williams & Wilkins Ovid Technologies,Wolters Kluwer
• Subject: Blood Pressure / Cardiovascular disease / Chronic obstructive pulmonary disease / Cohort analysis / Cohort Studies / Data collection / Dyspnea / Ethics / Heart / Hospital Mortality / Hospitals / Humans / Inpatients / Laboratories / Medical prognosis / Mortality / Original / Patients / Pulmonary Disease, Chronic Obstructive - mortality / Pulmonary Disease, Chronic Obstructive - therapy / Respiration, Artificial / Statistical analysis / Survival analysis / Ventilators