Prognosis of Prehospital Hypotensive Patients in the Emergency Department: A Retrospective Cohort Study

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.