Abstract
The aim of our study was to assess the association between the macrohemodynamic profile and sepsis induced acute kidney injury (AKI). We also investigated which minimally invasive hemodynamic parameters may help identify patients at risk for sepsis-AKI. We included 71 patients with sepsis and septic shock. We performed the initial fluid resuscitation using local protocols and continued to give fluids guided by the minimally invasive hemodynamic parameters. We assessed the hemodynamic status by transpulmonary thermodilution technique. Sequential organ failure assessment (SOFA score) (AUC 0.74, 95% CI 0.61–0.83, p < 0.01) and cardiovascular SOFA (AUC 0.73, 95% CI 0.61–0.83, p < 0.01) were found to be predictors for sepsis-induced AKI, with cut-off values of 9 and 3 points respectively. Persistent low stroke volume index (SVI) ≤ 32 mL/m2/beat (AUC 0.67, 95% CI 0.54–0.78, p < 0.05) and global end-diastolic index (GEDI) < 583 mL/m2 (AUC 0.67, 95% CI 0.54–0.78, p < 0.05) after the initial fluid resuscitation are predictive for oliguria/anuria at 24 h after study inclusion. The combination of higher vasopressor dependency index (VDI, calculated as the (dobutamine dose × 1 + dopamine dose × 1 + norepinephrine dose × 100 + vasopressin × 100 + epinephrine × 100)/MAP) and norepinephrine, lower systemic vascular resistance index (SVRI), and mean arterial blood pressure (MAP) levels, in the setting of normal preload parameters, showed a more severe vasoplegia. Severe vasoplegia in the first 24 h of sepsis is associated with a higher risk of sepsis induced AKI. The SOFA and cardiovascular SOFA scores may identify patients at risk for sepsis AKI. Persistent low SVI and GEDI values after the initial fluid resuscitation may predict renal outcome.
Highlights
Sepsis is still an important cause of morbidity and mortality in the intensive care unit (ICU) [1]
We considered the fluid resuscitation to be appropriate as we noticed an improvement in these macro- and micro-hemodynamic parameters
The main finding of our study is the fact that renal outcome in patients with sepsis and septic shock may be predicted by severe vasoplegia in the first 24 h of sepsis
Summary
Sepsis is still an important cause of morbidity and mortality in the intensive care unit (ICU) [1]. Sepsis is the leading cause of AKI in critically ill patients with a reported incidence of around 42.1% [3]. Identification and optimal management of patients at risk for sepsis AKI may lower the associated morbidity and mortality. The altered macrohemodynamic profile is one of the multiple triggers for sepsis induced AKI. The central role of the hemodynamic management in the prevention and treatment of patients with or at risk of sepsis AKI was already stated [6], but there is only limited research regarding the ability of the hemodynamic parameters in identifying the risk of AKI in the septic setting [7,8,9]
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