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BackgroundThis study used a prospective surgical database, to investigate the level of systolic blood pressure (SBP) at which the mortality rates begin to increase in septic surgical patients.MethodsAll acute, septic general surgical patients older than 15 years of age admitted between January 2012 and January 2015 were included in these analyses.ResultsOf a total of 6,020 adult surgical patients on the database, 3,053 elective patients, 1,664 nonseptic, 52 duplicates, and 11 patients with missing SBP were excluded to leave a cohort of 1,232 acute, septic surgical patients. The median age (intraquartile range [IQR]): 48 (32 to 62) and roughly 50:50 sex ratio (620 female: 609 male). Most of the patients were African: 988 (80.2%) followed by Asians (128 or 10.4%). More than two-thirds (852 or 69.2%) of the patient cohort underwent some form of surgery, and 152 or 12.3% required intensive care unit (ICU) admission. The median length of ICU stay (IQR) was 2 (1 to 4.5) days. The median length of total hospital stay (IQR) was 4 (2 to 9) days. The median SBP (IQR) on admission was 122 (107 to 138). A total of 167 patients died (13.6%). Those that died did have a significantly lower mean SBP compared with the survivors (116 vs 125, P ConclusionsOur data suggest that patients who die have a significantly lower SBP and clinically significant hypotension in sepsis with regard to increased mortality risk begins at a level of ∼111-mm Hg. This finding needs to be incorporated into bundles of care for surgical sepsis.

Original publication





American journal of surgery

Publication Date





941 - 945


Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg Metropolitan Hospital Complex; School of Clinical Medicine, University of the Western Cape, Cape Town, South Africa. Electronic address:


Humans, Sepsis, Shock, Septic, Hypotension, Critical Illness, Surgical Procedures, Operative, Registries, Cause of Death, Hospital Mortality, Area Under Curve, Risk Assessment, Survival Analysis, Follow-Up Studies, ROC Curve, Age Factors, Sex Factors, Databases, Factual, Adult, Middle Aged, Intensive Care Units, Female, Male