Impact of mean perfusion pressure and vasoactive drugs on occurrence and reversal of cardiac surgery-associate acute kidney injury: A cohort study

被引：11

作者：

Vandenberghe, Wim ^{[1
]}

Bove, Thierry ^{[2
]}

De Somer, Filip ^{[2
]}

Herck, Ingrid ^{[1
]}

Francois, Katrien ^{[2
]}

Peperstraete, Harlinde ^{[1
]}

Dhondt, Annemieke ^{[3
]}

Martens, Thomas ^{[2
]}

Schaubroeck, Hannah ^{[1
]}

Philipsen, Tine ^{[2
]}

Czapla, Jens ^{[2
]}

Claus, Isabelle ^{[2
]}

De Waele, Jan J. ^{[1
,4
]}

Hoste, Eric A. J. ^{[1
,4
]}

机构：

[1] Ghent Univ Hosp, Dept Crit Care Med, Ghent, Belgium

[2] Univ Ghent, Ghent Univ Hosp, Dept Cardiac Surg, Ghent, Belgium

[3] Univ Ghent, Ghent Univ Hosp, Dept Nephrol, Ghent, Belgium

[4] Res Fdn Flanders FWO, Brussels, Belgium

来源：

JOURNAL OF CRITICAL CARE | 2022年 / 71卷

关键词：

Acute kidney injury; Reversal; Cardiac surgery; vaso-inotropic score; CRITICALLY-ILL PATIENTS; CARDIOPULMONARY BYPASS; ARTERIAL-PRESSURE; VENOUS CONGESTION; EPIDEMIOLOGY; PROGRESSION; MORTALITY; OUTCOMES; DEFINITION; STATEMENT;

D O I：

10.1016/j.jcrc.2022.154101

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Purpose: Low cardiac output and kidney congestion are associated with acute kidney injury after cardiac surgery (CSA-AKI). This study investigates hemodynamics on CSA-AKI development and reversal. Materials and methods: Adult patients undergoing cardiac surgery were retrospectively included. Hemodynamic support was quantified using a new time-weighted vaso-inotropic score (VISAUC), and hemodynamic variables expressed by mean perfusion pressure and its components. The primary outcome was AKI stage >= 2 (CSA-AKI >= 2) and secondary outcome full AKI reversal before ICU discharge. Results: 3415 patients were included. CSA-AKI >= 2 occurred in 37.4%. Mean perfusion pressure (MPP) (OR 0.95,95%Cl 0.94-0.96, p < 0.001): and central venous pressure (CVP) (OR 1.17, 95%CI 1.13-122, p < 0.001) are associated with CSA-AKI >= 2 development, while VISAUC/h was not (p = 0.104). Out of 1085 CSA-AKI >= 2 patients not requiring kidney replacement therapy, 76.3% fully recovered of AKI. Full CSA-AKI reversal was associated with MPP (OR 1.02 per mmHg (95%CI 1.01-1.03. p = 0.003), and MAP (OR = 1.01 per mmHg (95%CI 1.00-1.02). p = 0.047), but not with VISAUC(p = 0.461). Conclusion: Development and full recovery of CSA-AKI >= 2 are affected by mean perfusion pressure, independent of vaso-inotropic use. CVP had a significant effect on AKI development, while MAP on full AKI reversal. (C) 2022 Elsevier Inc. All rights reserved.

引用

页数：11

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