Abstract
BackgroundThe relationship between cardiac output and septic acute kidney injury (AKI) remains unclear. The purpose of this study was to assess the association between the cardiac index (CI) and the renal outcomes in patients with septic shock.MethodsA one-year prospective cohort study was performed in the surgical and medical ICU of a teaching hospital in Nanjing, China. Twenty-nine septic shock patients who required early goal-directed fluid resuscitation were consecutively included. Pulse indicator continuous cardiac output (PiCCO) device was used to measure hemodynamic parameters before and after early goal-directed therapy (EGDT). Based on CI changes after EGDT, patients were assign to the CI increased group or the CI constant group, respectively. The incidence of poor renal outcome, which was defined as AKI on admission without recovery in following three days or new onset AKI within 28 days, was recorded. We investigated whether an increased CI was associated with a better renal outcome.ResultsAfter EGDT, there were 16 patients in the CI increased group and 13 patients in the CI constant group. The incidence of poor renal outcome was lower in CI increased group than in the CI constant group (6% vs. 62%; P = 0.003) with a relative risk of 0.10. The logistic regression showed that the CI percent change was associated with renal outcome, with an odd ratio of 0.003 (P = 0.056) after adjustment of possible confounding factors. The CI percent change would predict a good renal outcome (AU ROC 0.739, P = 0.012) with moderate accuracy (sensitivity 75% and specificity 89%) when using a 10% cut-off value from Youden index. The CI percent change was also positively correlated with creatinine clearance (CCr) after EGDT (ρ = 0.548; P = 0.002).ConclusionsThe increased CI after EGDT was a protective factor for kidney in patients with septic shock. A CI increased above 10% could be potentially used to predict development and reversibility of AKI in septic shock patients.Trial registrationClinicaltrials.gov:NCT01862588 (May 13, 2013).
Highlights
The relationship between cardiac output and septic acute kidney injury (AKI) remains unclear
We observed 16 patients with cardiac index (CI) increase (CI increased group) and the rest 13 patients were divided in CI constant group
The levels of CI, stroke volume index (SVI), global ejection fraction (GEF) and cardiac function index (CFI) after early goal-directed therapy (EGDT) were higher in the CI constant group than those in the CI increased group (Table 2)
Summary
The relationship between cardiac output and septic acute kidney injury (AKI) remains unclear. As a common comorbidity among septic shock patients, acute kidney injury (AKI) prolongs hospitalization and increases mortality [1,2,3,4]. Kidney perfusion could be improved through increasing the mean arterial press (MAP) by implement of vasopressors or fluid infusion. Vasopressors may, increase the renal vascular resistance, which result in a decrease in renal blood flow [8], making it difficult to set a MAP goal to attenuate AKI [9,10]. Achieving a high MAP goal was related to fluid overload, which may increase the risk of AKI [11,12]
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