Work

48-hour BPRI trajectories and 28-day mortality in vasoactive-supported hypertensive heart disease with heart failure

Year: 2026

Type: article

Abstract: Hypertensive heart disease (HHD) complicated by heart failure is associated with high mortality in intensive care units. The Blood Pressure Response Index (BPRI), the ratio of mean arterial pressure to vasoactive-inotropic score, integrates hemodynamic targets and treatment intensity, yet the prognostic value of its dynamic trajectories in this population remains unclear. This retrospective cohort study used MIMIC-IV v3.1 as the development cohort and eICU-CRD v2.0 as an independent replication cohort for trajectory patterns and trajectory–outcome associations. We included critically ill adults with a primary discharge code for hypertensive heart disease with heart failure who received vasoactive support during the first 48 h after ICU admission. Log-transformed BPRI values per 4-h window over 48 h were analyzed via group-based trajectory modeling. The primary outcome was 28-day all-cause mortality, assessed with multivariable Cox regression, logistic regression, and restricted cubic spline analysis. 1,078 patients from MIMIC-IV and 260 from eICU-CRD were analyzed. Five distinct BPRI trajectories were identified in both cohorts. The Persistently low BPRI group had the highest 28-day mortality (37.58% in MIMIC-IV; 37.21% in eICU-CRD). The fully adjusted hazard ratio for this high-risk group was 3.01 (95% CI 1.71–5.30) in the MIMIC-IV cohort, and the corresponding adjusted odds ratio was 2.37 (95% CI 1.13–4.56) in the eICU-CRD replication cohort. The 48-h mean log-BPRI showed a near-linear inverse association with mortality, with no significant subgroup interactions. In incremental predictive analyses, the 48-h BPRI trajectory model showed the highest apparent and optimism-corrected discrimination among the evaluated models. Among vasoactive-supported critically ill patients with discharge-coded hypertensive heart disease and heart failure, persistently low BPRI was associated with higher 28-day mortality.

Source: Scientific Reports

DOI: 10.1038/s41598-026-70610-6

Authors: Zijian Huang, Zefeng Chen, Zhuxuan Liu, Jiebin Zheng, Bo Chen

Institutions: Eighth Affiliated Hospital of Sun Yat-sen University, Shantou University, Cancer Hospital of Shantou University Medical College, First Affiliated Hospital of Shantou University Medical College, Shantou University Medical College

Language: English

Topic: Heart Failure Treatment and Management

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,690