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

Chen Zhou; Qun YI; Yuanming Luo; Hailong Wei; Huiqing GE; Huiguo Liu; Xianhua LI; Jianchu Zhang; Pinhua Pan; Mengqiu YI; Lina Cheng; Liang Liu; Jiarui Zhang; Lige Peng; Adila Aili; Yu Liu; Jiaqi PU; Haixia Zhou

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

Author: Chen ZHOU ¹ ; Qun YI ² ; Yuanming LUO ³ ; Hailong WEI ⁴ ; Huiqing GE ⁵ ; Huiguo LIU ⁶ ; Xianhua LI ⁷ ; Jianchu ZHANG ⁸ ; Pinhua PAN ⁹ ; Mengqiu YI ¹⁰ ; Lina CHENG ¹⁰ ; Liang LIU ¹¹ ; Jiarui ZHANG ² ; Lige PENG ² ; Adila AILI ² ; Yu LIU ² ; Jiaqi PU ² ; Haixia ZHOU ²
Author Information

1. West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China.
2. Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
3. State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, Guangdong 510120, China.
4. Department of Respiratory and Critical Care Medicine, People's Hospital of Leshan, Leshan, Sichuan 614000, China.
5. Department of Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China.
6. Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
7. Department of Respiratory and Critical Care Medicine, The First People's Hospital of Neijiang City, Neijiang, Sichuan 641000, China.
8. Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China.
9. Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
10. Department of Emergency, the First People's Hospital of Jiujiang, Jiujiang, Jiangxi 332000, China.
11. Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Chengdu University, Chengdu, Sichuan 610041, China.
Publication Type:Multicenter Study
MeSH: Humans; Blood Pressure; Pulmonary Disease, Chronic Obstructive/therapy*; Cohort Studies; Respiration, Artificial; Inpatients; Hospital Mortality
From: Chinese Medical Journal 2023;136(8):941-950
CountryChina
Language:English
Abstract: 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.