J Korean Soc Emerg Med.  2016 Dec;27(6):572-579. 10.0000/jksem.2016.27.6.572.

Predictive Factor of Blood Pressure Lowering in Patients with Fever Using Propacetamol

• Kwack C
• Choi H
• Lee JH
• In YN
• Min JH
• Park JS
• Kim H
• Lee SW

• KMID: 2369045
• DOI: http://doi.org/10.0000/jksem.2016.27.6.572

Abstract

PURPOSE
This study aimed to identify predictive factors for decreased blood pressure in patients prescribed with propacetamol in the emergency room using clinical and laboratory indicators of sepsis.
METHODS
Among patients aged 18 years or older with a fever, who visited Chungbuk National University hospital's emergency room between July and December of 2014, 246 patients underwent intravenous infusion of propacetamol to control body temperature. Of these, 112 patients fulfilled all study requirements. Patients whose systolic or diastolic blood pressure dropped below 90 mmHg or 60 mmHg, respectively, were included in the blood pressure decline group. Additional inclusion criteria were a decline in systolic blood pressure of more than 30-mmHg and thereby treated with fluids or inotropics after intravenous infusion of propacetamol. Remaining patients were included in the blood pressure maintenance group. The relationship of each factor between the two groups was then investigated.
RESULTS
Twenty-nine patients (25.9%) showed a significant decrease in blood pressure, and among many factors, high-sensitivity C-reactive protein (hs-CRP) (cut off value, 11.86; sensitivity, 72.4%; specificity, 69.9%; area under curve [AUC], 0.698) and procalcitonin (cut off value, 0.67; sensitivity, 75.9%; specificity, 60.2%; AUC, 0.667) levels showed a statistically significant effect. Of the 29 patients with a decrease in blood pressure, 10 patients received fluids and inotropics; procalcitonin in particular showed a significant effect.
CONCLUSION
When propacetamol is administered to patients at the emergency room, and if hs-CRP or procalcitonin levels are high, there is an increased risk of a decrease in blood pressure. In particular, if procalcitonin levels are high, aggressive treatment is required, such as administration of inotropics in addition to fluids.

Keyword

Blood pressure; Fever; Procalcitonin; Propacetamol

MeSH Terms

Area Under Curve
Blood Pressure*
Body Temperature
C-Reactive Protein
Chungcheongbuk-do
Emergency Service, Hospital
Fever*
Humans
Infusions, Intravenous
Sensitivity and Specificity
Sepsis
C-Reactive Protein