Early blood pressure drop exacerbates renal function deterioration and mortality in ICU patients with liver failure

Abstract

Abstract Background: The relationship between early blood pressure drop and worsening renal function (WRF) in this patient population is currently unknown but has significant clinical importance. The aim of this study is to investigate the association between early blood pressure drop and WRF in intensive care unit (ICU) patients with liver failure and to evaluate their clinical outcomes, which may improve patient prognosis and clinical management strategies. Method: This retrospective study utilized data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) version 2.2 database. The study included ICU patients with liver failure who met specific inclusion criteria. Descriptive statistics, analysis of variance (ANOVA), the Kruskal-Wallis test, and the chi-square test were used for the analysis. Multivariate linear regression models were used to assess the determinants of blood pressure drop. Cox proportional hazards and generalized additive models were used to evaluatethe relationship between blood pressure drop, WRF, and 60-day in-hospital mortality. Subgroup analyses and log-rank tests were performed. Results: Peak systolic blood pressure (SBP) drop was independently associated with a higher risk of WRF (HR: 1.08 per 10 mmHg SBP drop; P < 0.001) and 60-day in-hospital death (HR: 1.14 per 10 mm Hg SBP drop; P <0.001), even after adjusting for potential confounders including baseline SBP. Patients experiencing a peak blood pressure drop above the median and those developing WRF faced a heightened risk of 60-day in-hospital mortality; however, the P-value for interaction was >0.05. The independent risk relationship observed between peak diastolic blood pressure (DBP) and mean arterial pressure (MAP) drop, and the occurrence of WRF and 60-day in-hospital mortality, was similar to that of the peak SBP drop. Conclusions: In ICU patients with liver failure, a significant early drop in blood pressure was associated with a higher incidence of WRF, increased risk of 60-day in-hospital mortality, and a poorer prognosis.