Key result
Low admission diastolic blood pressure (<70 mmHg) was associated with an increased risk of all-cause in-hospital mortality (HR 2.16; 95% CI 1.53-3.05; P<0.01) in patients with AECOPD.
Why the study?
Does low on-admission diastolic blood pressure predict adverse outcomes in inpatients with acute exacerbation of chronic obstructive pulmonary disease?
Cohort (n=13,633)
Yes
Does low on-admission diastolic blood pressure predict adverse outcomes in inpatients with acute exacerbation of chronic obstructive pulmonary disease?
Low on-admission diastolic blood pressure (<70 mmHg) is associated with an increased risk of in-hospital mortality and adverse outcomes in patients with acute exacerbation of COPD.
Answers are grounded in this paper and cite their sources.
Low admission DBP may flag higher risk in AECOPD inpatients; leaves open whether targeting DBP alters outcomes.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trail Registry, No. ChiCTR2100044625.
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Zhou et al. (2003) conducted a cohort in Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) (n=13,633). Low diastolic blood pressure on admission (<70 mmHg) vs. Higher diastolic blood pressure was evaluated on All-cause in-hospital mortality (HR 2.16, 95% CI 1.53-3.05, p=<0.01). Low admission diastolic blood pressure (<70 mmHg) was associated with an increased risk of all-cause in-hospital mortality (HR 2.16; 95% CI 1.53-3.05; P<0.01) in patients with AECOPD.
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