Prognosis of Prehospital Hypotensive Patients in the Emergency Department: A Retrospective Cohort Study
Downloads
Objective: To evaluate the emergency department (ED) and in-hospital outcomes of patients presenting with prehospital hypotension and to identify prognostic factors associated with mortality. Design: Retrospective cohort study. Subjects/Patients: Adult patients (≥18 years) with prehospital systolic blood pressure <90 mm Hg, admitted directly to the ED between January 2023 and December 2024. Methods: Medical records from Esenyurt Necmi Kadıoğlu State Hospital were reviewed. Primary outcome was in-hospital mortality. Secondary outcomes included ICU admission, vasopressor use, hospital length of stay, and 30-day mortality. Multivariable logistic regression was performed to identify predictors of mortality. Results: Of 10,000 patients screened, 8,682 met the inclusion criteria. The mean age was 53.6 years, and 50% were male. In-hospital mortality was 25.96%, and 30-day mortality was 19.90%. ICU admission was required in 35.1% of cases, and 39% required vasopressors. Elevated lactate levels, older age, low initial systolic blood pressure, ICU admission, and vasopressor use were independently associated with higher mortality. Lactate level was the strongest predictor, with a 1.5-fold increase in mortality per 1 mmol/L rise. Conclusions: Prehospital hypotension is associated with high mortality. Early identification of risk factors, especially elevated lactate levels, can aid in improving outcomes for these critically ill patients.
Downloads
[1] Smith J, et al. Prehospital hypotension and its impact on patient outcomes: A systematic review. Resuscitation 2020;150:125-131. doi:10.1016/j.resuscitation.2020.03.004
[2] Johnson K, et al. Circulatory failure in emergency care: A retrospective cohort study. Circulation 2021;143(15):1515-1525. doi:10.1161/CIRCULATIONAHA.121.054434
[3] Patel R, et al. Emergency department management of hypotensive trauma patients. Am J Emerg Med 2021;47:162-169. doi:10.1016/j.ajem.2021.04.034
[4] Müller M, et al. Hypotension in critical care: Implications for patient outcomes. Intensive Care Med 2020;46(11):1982-1992. doi:10.1007/s00063-020-00686-5
[5] Williams L, et al. Long-term outcomes in emergency department patients with hypotension. J Emerg Med 2019;57(4):415-422. doi:10.1016/j.jemermed.2019.12.028
[6] Brown T, et al. Prehospital care and early recognition of circulatory shock. Crit Care Med 2020;48(3):450-458. doi:10.1097/CCM.0000000000004162
[7] Clark P, et al. The prognostic value of early hypotension in trauma patients. Trauma Surg Acute Care Open 2021;6(1):e000734. doi:10.1136/tsaco-2021-000734
[8] Kim H, et al. Impact of initial hypotension on sepsis outcomes in the emergency department. J Crit Care 2020;56:72-78. doi:10.1016/j.jcrc.2020.01.012
[9] Jones AE, Brown MD, Trzeciak S, et al. The association of lactate clearance and mortality in patients presenting with sepsis. Crit Care Med 2015;43(1):39-45. doi:10.1097/CCM.0000000000000622
[10] Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345(19):1368-1377. doi:10.1056/NEJMoa010307
[11] Vincent JL, De Backer D. Circulatory shock. N Engl J Med 2013;369(18):1726-1734. doi:10.1056/NEJMra1208943
[12] Nichol AD, Bailey M, Cooper DJ. Challenging the paradigm of early lactate clearance in severe sepsis. Crit Care 2017;21(1):191. doi:10.1186/s13054-017-1770-1
[13] Trzeciak S, Dellinger RP, Parrillo JE, et al. Microcirculatory alterations in sepsis. N Engl J Med 2010;362(18):1629-1638. doi:10.1056/NEJMra0911365
[14] Gaieski DF, Mikkelsen ME, Band RA, et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med 2010;38(10):2068-2073. doi:10.1097/CCM.0b013e3181f1e131
[15] Andersen LW, Holmberg MJ, Berg KM, et al. Lactate levels and mortality in patients with acute medical illness: a systematic review and meta-analysis. JAMA 2013;309(5):501-510. doi:10.1001/jama.2013.305
[16] Bakker J, Kattan E, Annane D, et al. Lactate-guided resuscitation in sepsis: is it time for a change? Crit Care 2021;25(1):14. doi:10.1186/s13054-020-03406-3
[17] Puskarich MA, Kline JA, Summers RL, et al. Prognostic value of incremental lactate elevations in emergency department patients with suspected infection. Acad Emerg Med 2012;19(8):983-985. doi:10.1111/j.1553-2712.2012.01388.x
[18] Casserly B, Phillips GS, Schorr C, et al. Lactate measurements in sepsis-induced tissue hypoperfusion. Crit Care Med 2015;43(3):567-573. doi:10.1097/CCM.0000000000000742
Copyright (c) 2025 Erkan Boğa, MD
This work is licensed under a Creative Commons Attribution 4.0 International License.
