Optimal ambulatory vital sign targets in pulmonary hypertension pregnant
women via time-dependent survival analysis
Abstract
Objective To investigate the safe range of vital signs of pregnant women
pulmonary hypertension (PH). Study design Retrospective study. Setting
The largest First-class Hospital at grade 3 in Northwestern China
Population pregnant women with PH in Intensive care unit (ICU). Methods
This of consecutive obstetric patients with PH admitted to ICU of the
First Affiliated Hospital of Air Force Military Medical University of
China, from January 2011 to May 2020, consisted of 92 cases analyzed
using time-dependent Cox regression to consider the dynamic features of
vital signs. Main outcome measures Maternal mortality Results 7/92
maternal deaths occurred. Three vital signs were identified as risk
factors in the maternal in-hospital mortality model via backward
selection: SpO2(HR,0.93;95%CI,0.88-0.97;P=0.003), heart
rate(HR,0.94;95%CI,0.90-0.99;P=0.027), and mean arterial pressure
(MAP) (HR,1.09;95%CI,1.00-1.18;P=0.045). The optimal range of
SpO2 <73%, MAP was 65–95 mmHg, and heart rate was 59–125
beats per minute (bpm). Further exploration showed that the cumulative
and the longest consecutive time of abnormal vital signs also affect the
outcome. For example, SpO2<73% accumulated for 5 h or
continuously up to 2 h increases mortality. Conclusions: Maintaining
SpO2>73%, MAP at 65–95mmHg, and heart rate at 59–125 bpm
can significantly reduce in-hospital maternal mortality. The effects of
the abnormal SpO2, heart rate, and MAP on in-hospital maternal mortality
should be combined with the cumulative time and the longest duration.
Funding Dr. Binxiao Su is supported by the National Institutes of Health
(NIH) grant 81870961