Hemodynamic changes after propacetamol administration in patients with febrile UTI in the ED

Objectives

Clinical studies have indicated that transient hypotension can occur after propacetamol administration. This study aimed to analyze the hemodynamic changes after propacetamol administration in patients visiting the ED due to febrile UTI. We also examined the incidence of propacetamol-induced hypotension and compared the clinical characteristics of patients with persistent hypotension, defined as requiring additional fluids or vasopressors, to those with transient hypotension.

Methods

A retrospective analysis of the electronic medical records of patients who visited the ED between June 2015 and May 2016, were diagnosed with febrile UTI, and treated with propacetamol, was conducted.

Results

We included 195 patients in this study; of these, 87 (44.6%) showed hypotension. In all patients, significant decreases in systolic blood pressure (SBP; 135.06 ± 20.45 mm Hg vs 117.70 ± 16.41 mm Hg), diastolic blood pressure (DBP; 79.74 ± 12.17 mm Hg vs 69.69 ± 10.96 mm Hg), and heart rate (97.46 ± 17.14 mm Hg vs 90.72 ± 14.90 mm Hg) were observed after propacetamol administration. The basal SBP and DBP were higher in the hypotension than in the non-hypotension group (basal SBP: 144.4 ± 22.3 mm Hg vs 127.6 ± 15.3 mm Hg; basal DBP: 83.3 ± 12.6 mm Hg vs 76.9 ± 11.0 mm Hg). Patients with persistent hypotension had a lower baseline BP, which was not elevated despite fever, and a higher rate of bacteremia than those with transient hypotension.

Conclusions

Although febrile UTI patients treated with propacetamol in the ED showed hemodynamic changes, these changes did not have a large effect on their prognosis. However, in patients who showed bacteremia or a normal initial BP despite fever, the possibility of developing persistent hypotension should be considered.