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Pulse pressure predicts mortality in elderly patients.

ABSTRACT: BACKGROUND: Pulse pressure (PP) values increase with age. The impact of PP on mortality in elderly patients has not been established. OBJECTIVES: To evaluate the effect of PP on mortality among very elderly hospitalized patients. DESIGN: A prospective clinical study. PARTICIPANTS AND MEASUREMENTS: The medical records of 420 inpatients aged >60 (187 males, mean age of 81.4 +/- 7 years) hospitalized in an acute geriatric ward were reviewed. Patients were followed up for a mean of 3.46 +/- 1.87 years. Mortality data were extracted from death certificates. Using relative operating characteristic (ROC) curves, we identified PP of 62.5 mmHg as a cutoff point. Subjects were categorized as having low PP (< or = 62.5 mmHg; N = 116) or high PP (>62.5 mmHg; N = 304). MAIN RESULTS: The mortality rate was greater in patients with high PP than in those with low PP. During the follow-up, 201 patients died, 155 patients (51%) in the high PP group and 46 patients (39.7%) in the low PP group (p = 0.038). Pulse pressure was associated with all-cause mortality (HR = 1.69, 95% CI = 1.19-2.38, p = 0.003) even after controlling for gender, age, diabetes mellitus, atrial fibrillation and heart rate. CONCLUSION: High PP is an independent predictor of mortality among elderly hospitalized patients.

SUBMITTER: Weiss A

PROVIDER: S-EPMC2710466 | biostudies-other | 2009 Aug

REPOSITORIES: biostudies-other

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Project description:Background and purposePrevious studies have described an association between pulse pressure (PP) level and mortality in stroke patients. Evidence of associations between PP level and the risk of mortality remains unknown in non-traumatic subarachnoid hemorrhage (SAH) patients. We aimed to explore the relationship between the baseline PP level and hospital mortality.MethodsThis cohort study of 693 non-traumatic SAH adults used Medical Information Mart for Intensive Care (MIMIC-IV) data from 2008-2019 admissions to Intensive Care Unit (ICU). PP level was calculated as the first value after admission to the ICU. The endpoint of the study was in-hospital mortality. Cox proportional hazards models were utilized to analyze the association between baseline PP level and hospital mortality. Restricted Cubic Splines (RCS) analysis was utilized to determine the relationship curve between hospital mortality and PP level and examine the threshold saturation effect. We further applied Kaplan-Meier survival curve analysis to examine the consistency of these correlations. The interaction test was used to identify subgroups with differences.ResultsThe mean age of the study population was 58.8 ± 14.6 years, and 304 (43.9%) of participants were female. When baseline PP level was assessed in quartiles, compared to the reference group (Q1 ≤ 56 mmHg), the adjusted hazard ratio (HR) in Q2 (57-68 mmHg), Q3(69-82 mmHg), Q4 (≥83 mmHg) were 0.55 (95% CI: 0.33-0.93, p = 0.026), 0.99 (95% CI, 0.62-1.59, p = 0.966), and 0.99 (95% CI: 0.62-1.59, p = 0.954), respectively. In the threshold analysis, for every 5 mmHg increase in PP level, there was an 18.2% decrease in hospital mortality (adjusted HR, 0.818; 95% CI, 0.738-0.907; p = 0.0001) in those with PP level less than 60 mmHg, and a 7.7% increase in hospital mortality (adjusted HR, 1.077; 95% CI, 1.018-1.139; p = 0.0096) in those with PP level was 60 mmHg or higher.ConclusionFor patients with non-traumatic SAH, the association between baseline PP and risk of hospital mortality was non-linear, with an inflection point at 60 mmHg and a minimal risk at 57 to 68 mmHg (Q2) of baseline PP level.

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Pulse pressure predicts mortality in elderly patients.

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