Mean arterial pressure and mean perfusion pressure deficit in septic acute kidney injury.

Abstract:

BACKGROUND:Changes in mean perfusion pressure (MPP) from premorbid resting values may contribute to the progression of septic acute kidney injury (AKI). OBJECTIVES:In patients with septic shock, we aimed to investigate the association of changes from premorbid values with AKI severity and progression. METHODS:We obtained premorbid resting mean arterial pressure (MAP), central venous pressure (CVP), and MPP, and then recorded data from intensive care unit admission 2 hourly for the first 24 hours to calculate hemodynamic deficits. We recorded 4-hourly creatinine measurements for 96 hours. The association of hemodynamic variables with progression of AKI by Kidney Disease: Improving Global Outcomes ≥2 stages was explored by multivariate logistic regression. RESULTS:Of 107 patients, 55 (51.4%) had severe AKI. Median MAP deficit was similar for patients with or without severe AKI. Median MPP deficit was 29% in patients with severe AKI and 24% in those without (P = .04), a difference determined by greater CVP levels. Central venous pressure was independently associated with worsening AKI (odds ratio, 1.26 [95% confidence interval, 1.01-1.58]; P = .04). CONCLUSIONS:Mean arterial pressure and MPP deficits were substantial in septic shock patients, with patients with severe AKI having a greater MPP deficit. However, only CVP was independently associated with AKI progression. These findings suggest a possible role for venous congestion in septic AKI.

journal_name

J Crit Care

journal_title

Journal of critical care

authors

Wong BT,Chan MJ,Glassford NJ,Mårtensson J,Bion V,Chai SY,Oughton C,Tsuji IY,Candal CL,Bellomo R

doi

10.1016/j.jcrc.2015.05.003

subject

Has Abstract

pub_date

2015-10-01 00:00:00

pages

975-81

issue

5

eissn

0883-9441

issn

1557-8615

pii

S0883-9441(15)00270-1

journal_volume

30

pub_type

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