TY - JOUR
T1 - Hypotension during intensive care stay and mortality and morbidity
T2 - a systematic review and meta-analysis
AU - Schuurmans, Jaap
AU - van Rossem, Benthe T. B.
AU - Rellum, Santino R.
AU - Tol, Johan T. M.
AU - Kurucz, Vincent C.
AU - van Mourik, Niels
AU - van der Ven, Ward H.
AU - Veelo, Denise P.
AU - Schenk, Jimmy
AU - Vlaar, Alexander P. J.
N1 - Publisher Copyright: © The Author(s) 2024.
PY - 2024/4
Y1 - 2024/4
N2 - Purpose: The aim of this study is to provide a summary of the existing literature on the association between hypotension during intensive care unit (ICU) stay and mortality and morbidity, and to assess whether there is an exposure-severity relationship between hypotension exposure and patient outcomes. Methods: CENTRAL, Embase, and PubMed were searched up to October 2022 for articles that reported an association between hypotension during ICU stay and at least one of the 11 predefined outcomes. Two independent reviewers extracted the data and assessed the risk of bias. Results were gathered in a summary table and studies designed to investigate the hypotension-outcome relationship were included in the meta-analyses. Results: A total of 122 studies (176,329 patients) were included, with the number of studies varying per outcome between 0 and 82. The majority of articles reported associations in favor of ‘no hypotension’ for the outcomes mortality and acute kidney injury (AKI), and the strength of the association was related to the severity of hypotension in the majority of studies. Using meta-analysis, a significant association was found between hypotension and mortality (odds ratio: 1.45; 95% confidence interval (CI) 1.12–1.88; based on 13 studies and 34,829 patients), but not for AKI. Conclusion: Exposure to hypotension during ICU stay was associated with increased mortality and AKI in the majority of included studies, and associations for both outcomes increased with increasing hypotension severity. The meta-analysis reinforced the descriptive findings regarding mortality but did not yield similar support for AKI.
AB - Purpose: The aim of this study is to provide a summary of the existing literature on the association between hypotension during intensive care unit (ICU) stay and mortality and morbidity, and to assess whether there is an exposure-severity relationship between hypotension exposure and patient outcomes. Methods: CENTRAL, Embase, and PubMed were searched up to October 2022 for articles that reported an association between hypotension during ICU stay and at least one of the 11 predefined outcomes. Two independent reviewers extracted the data and assessed the risk of bias. Results were gathered in a summary table and studies designed to investigate the hypotension-outcome relationship were included in the meta-analyses. Results: A total of 122 studies (176,329 patients) were included, with the number of studies varying per outcome between 0 and 82. The majority of articles reported associations in favor of ‘no hypotension’ for the outcomes mortality and acute kidney injury (AKI), and the strength of the association was related to the severity of hypotension in the majority of studies. Using meta-analysis, a significant association was found between hypotension and mortality (odds ratio: 1.45; 95% confidence interval (CI) 1.12–1.88; based on 13 studies and 34,829 patients), but not for AKI. Conclusion: Exposure to hypotension during ICU stay was associated with increased mortality and AKI in the majority of included studies, and associations for both outcomes increased with increasing hypotension severity. The meta-analysis reinforced the descriptive findings regarding mortality but did not yield similar support for AKI.
KW - Hypotension
KW - Intensive care unit
KW - Meta-analysis
KW - Morbidity
KW - Mortality
UR - http://www.scopus.com/inward/record.url?scp=85182825620&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00134-023-07304-4
DO - https://doi.org/10.1007/s00134-023-07304-4
M3 - Review article
C2 - 38252288
SN - 0342-4642
VL - 50
SP - 516
EP - 525
JO - Intensive care medicine
JF - Intensive care medicine
IS - 4
ER -