MAP of 70‒75 mm Hg confers survival benefits on cirrhosis patients with septic shock

Maintenance of mean arterial pressure between 70 and 75 mm Hg helps improve survival and kidney recovery in patients with decompensated cirrhosis and septic shock, suggests a study.

A total of 1,145 decompensated cirrhosis patients with septic shock (mean age 64 years, 43 percent female, 19 percent non-White participants, 38 percent alcohol-associated cirrhosis, Model for End-Stage Liver Disease 26) were included in the analysis. Of these, 66 percent had acute kidney injury (AKI), with 37 percent nonrecovery. Mortality rate within 28 days stood at 56 percent.

Increasing the time weighted average MAP from <60 mm Hg to 75 mm Hg resulted in a stepwise reduction in the likelihood of 28-day mortality (<60 odds ratio [OR], 2.775; <65 OR, 1.607; <70 OR, 1.305; <75 OR, 1.180). However, the survival benefit reached a plateau at >75 mm Hg.

Similar associations were observed for AKI nonrecovery (<60 OR, 1.151; <65 OR, 1.153; <70 OR, 1.110; <75 OR, 1.079), with the reduction lessened at >75 mm Hg.

This multicentre retrospective analysis involved decompensated cirrhosis patients with septic shock admitted to intensive care units across 20 hospitals in Texas, US, between 1 January 2014 and 31 December 2022.

The authors calculated the time weighted average MAP during the initial 72 h of admission to quantify hypotension exposure. They also used multivariable logistic regression models to assess the impact of various time weighted average MAP thresholds (60‒90 mm Hg) on 28-day mortality and AKI nonrecovery, with adjustments for relevant confounders.

“Randomized trials are needed to compare traditional MAP targets (60–65 mm Hg) with intermediate targets (70–75 mm Hg) to improve outcomes in this high-risk population,” the authors said.