Association between early systolic blood pressure and clinical outcomes in non-critically ill patients with sepsis-associated acute kidney injury: a retrospective cohort study.

Authors

Teerawat Sriwalosakul, Surachet Vongsanim, Karn Pongsuwan, Prit Kusirisin, Surapon Nochaiwong, Chidchanok Ruengorn, Kajohnsak Noppakun

Published in

Annals of medicine. Volume 58. Issue 1. Pages 2735092. Epub Sep 22, 2026.

Abstract

Sepsis-associated acute kidney injury (SA-AKI) is associated with poor outcomes. Evidence regarding the relationship between early systolic blood pressure (BP) and clinical outcomes in non-critically ill patients with SA-AKI remains limited. This study aimed to investigate the association between mean systolic BP during the first 48 h after admission and one-year clinical outcomes in this population.
We conducted a single-center retrospective cohort study of non-critically ill adults with SA-AKI admitted between 2011 and 2020. SA-AKI was defined by a sequential organ failure assessment (SOFA) score increase ≥2 and AKI occurring within 48 h of admission. The exposure was mean systolic BP over the first 48 h (seven measurements at baseline and every 8 h), categorized as ≤100, 101-120, 121-140, and >140 mmHg. Patients were followed for one year. The primary outcome was a composite of ≥25% decline in estimated glomerular filtration rate, long-term dialysis, and one-year mortality.
Of 2,920 screened patients, 476 were included. Mean age was 68.4 ± 14.5 years, and 55% were male. AKI stages I, II, and III occurred in 55%, 21%, and 24%, respectively. The primary composite outcome was most frequent in the ≤100 mmHg group (80%) compared with 101-120 (51%), 121-140 (50%), and >140 mmHg (46%) (p < 0.001). In adjusted analyses, mean systolic BP ≤100 mmHg was associated with higher composite outcome (HR 1.84, 95% CI 1.15-2.93; p = 0.010). One-year mortality was highest in systolic BP ≤100 mmHg group (73% vs. 32% in 121-140 mmHg; p < 0.001), with increased adjusted hazards for one-year mortality (HR 2.89, 95% CI 1.68-4.99) and 30-day mortality (HR 2.79, 95% CI 1.12-6.96).
In non-critically ill patients with SA-AKI, early mean systolic BP ≤100 mmHg within 48 h was associated with worse one-year outcomes, driven largely by higher mortality. Early systolic BP may serve as a prognostic marker for high-risk patients.

PMID:
42768944
Bibliographic data and abstract were imported from PubMed on 22 Sep 2026.

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