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J Korean Soc Emerg Med > Volume 27(6); 2016 > Article
Journal of The Korean Society of Emergency Medicine 2016;27(6): 572-579.
발열환자에서 프로파세타몰 사용시 발생하는 혈압저하의 예측인자 연구
곽치환, 최홍락, 이지한, 인용남, 민진홍, 박정수, 김훈, 이석우
충북대학교 의과대학 응급의학교실
Predictive Factor of Blood Pressure Lowering in Patients with Fever Using Propacetamol
Chihwan Kwack, Honglak Choi, Ji Han Lee, Yong Nam In, Jin Hong Min, Jung Soo Park, Hoon Kim, Suk Woo Lee
Department of Emergency Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
Correspondence  Ji Han Lee ,Tel: 043-269-6994, Fax: 043-269-6954, Email: capcloud80@hanmail.net,
Received: September 3, 2016; Revised: September 5, 2016   Accepted: September 26, 2016.  Published online: December 31, 2016.
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.
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.
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.
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.
Key words: Blood pressure, Fever, Procalcitonin, Propacetamol
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