To the Editor Dr Futier and colleagues1 concluded that management targeting an individualized SBP minimized the risk of postoperative organ dysfunction compared with standard management. The authors used a composite primary outcome. Composite outcomes should include components that are of comparable severity and occur with similar frequency.2 It was not appropriate to combine the less severe and more common RIFLE (risk, injury, failure, loss of kidney function, and end-stage kidney disease) stage risk with the more severe and less common myocardial infarction, nor a Glasgow Coma Scale score of 14 or less with stroke. The incidence of acute kidney dysfunction was relatively large, so that it overwhelmed the other components of the composite primary outcome and effectively became the primary outcome.
Daoud M. Organ Dysfunction After Surgery in Patients Treated With Individualized or Standard Blood Pressure Management. JAMA. 2018;319(7):720–721. doi:10.1001/jama.2017.20931
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