Mean arterial pressure target of 75 mmHg may boost survival in cirrhosis with septic shock

Key takeaways:

• Increasing the mean arterial pressure target from 55 mmHg to 75 mmHg decreased the odds for 28-day mortality by 85%.
• An increase from 65 mmHg also decreased the odds for acute kidney injury nonrecovery by 8%.

SAN DIEGO — Increasing the mean arterial pressure target to 75 mmHg lowered the odds of 28-day mortality by 85%, and also reduced the odds of acute kidney injury nonrecovery, in decompensated cirrhosis with septic shock, according to data.

“Maintaining a target mean arterial pressure (MAP), specifically a MAP greater than or equal to 65 mmHg, is central to the management of sepsis in patients without cirrhosis to improve survival and kidney function,” Kavish Patidar, DO, assistant professor of medicine at Baylor College of Medicine, told Healio. “However, the optimal MAP target in patients with cirrhosis and sepsis is currently unclear.

“Various guidelines in patients with cirrhosis recommend different MAP targets which were either extrapolated from data in patients without cirrhosis or based on expert consensus.”

In a study presented at The Liver Meeting, Patidar and colleagues aimed to investigate the association between MAP targets and 28-day survival and recovery after acute kidney injury (AKI) among patients with decompensated cirrhosis admitted to the ICU with septic shock between 2014 and 2022.

In addition to evaluating MAP trends within the first 72 hours of admission, the researchers examined the independent association of MAP improvement after adjusting for several factors, including early fluids and antibiotics, demographics, MELD score and age.

Overall, the researchers assessed 1,729 patients (mean age, 64 years; 43% women; 72% AKI; mean MELD score = 23) with 151,734 MAP observations — a mean of 136 observations per patient in 72 hours. More than half of the patients (54%) died within 28 days, and of those with AKI, 42% recovered.

According to Patidar, increasing MAP from 55 mmHg to 75 mmHg decreased the odds of mortality by 85%, while increasing it from 65 mmHg to 75 mmHg decreased the odds of AKI nonrecovery by 8%.

“MAP is strongly associated with 28-day mortality and AKI nonrecovery,” Patidar told Healio. “For both outcomes, we did not find any further major benefit for increasing MAP beyond 75 mmHg.”

The researchers also reported that odds of mortality were “significantly lower” with early fluids and antibiotics (OR = 0.54), MAP and early antibiotics (OR = 0.44), with 67% lower odds upon receipt of all three interventions (OR = 0.37; 95% CI, 0.23-0.6).

“Results from our study could lead to a more structured approach to managing MAP in this population, resulting in improved patient outcomes, enhanced clinician guidance and potentially more efficient use of health care resources,” Patidar said. “Since our data only show associations, not causation, further randomized controlled trials are needed to compare lower MAP targets — 60 mmHg to 65 mmHg — with intermediate targets — 70 mmHg to 75 mmHg — to better determine the optimal MAP for this patient population.”