Abstract
BackgroundThe aim was to investigate whether mean perfusion pressure (MPP) calculated as the difference between mean arterial pressure (MAP) and central venous pressure (CVP) was associated with risk of progression from AKI I to AKI III in critically ill patients.MethodsRetrospective analysis of adult patients admitted to a multi-disciplinary adult intensive care unit (ICU) between July 2007 and June 2009 who developed AKI I and in whom advanced haemodynamic monitoring was initiated within 12 h of diagnosis of AKI I. We compared patients with a MPP above and below the median value in the first 12 h of diagnosis of AKI. Multivariable logistic regression analyses were performed to identify independent risk factors for progression to AKI III, to explore the impact of MAP and CVP separately, and to investigate the impact of MPP in pre-defined sub-groups.ResultsAmong 2118 ICU patients, 790 patients (37%) developed AKI I of whom 205 underwent advanced haemodynamic monitoring within 12 h of AKI stage I. Their median MPP was 59 mmHg. AKI I patients with a MPP ≤59 mmHg had a significantly higher risk of progressing to AKI stage III (48.6% versus 34%, respectively; p = 0.0034). This association was stronger in patients with ischemic heart disease, congestive cardiac failure or without pre-existing hypertension and in patients with a MAP <65 mmHg for >1 h. As individual components, a raised CVP was independently associated with progression to AKI stage III but MAP alone was not an independent risk factor for AKI progression.ConclusionMPP <60 mmHg was independently associated with AKI progression. CVP was the key component of MPP.
Highlights
The aim was to investigate whether mean perfusion pressure (MPP) calculated as the difference between mean arterial pressure (MAP) and central venous pressure (CVP) was associated with risk of progression from Acute kidney injury (AKI) I to AKI III in critically ill patients
I) to explore whether patients with a new diagnosis of AKI stage I and a calculated MPP below the median value had a higher risk of progression to AKI stage III than AKI I patients with a MPP above the median; ii) to investigate whether MAP or CVP as individual components of MPP have a greater impact on risk of progression from AKI stage I to AKI stage III
We found that the relationship between MPP and AKI progression was primarily based on an independent association between CVP and AKI
Summary
The aim was to investigate whether mean perfusion pressure (MPP) calculated as the difference between mean arterial pressure (MAP) and central venous pressure (CVP) was associated with risk of progression from AKI I to AKI III in critically ill patients. Acute kidney injury (AKI) is one of the most common complications of critical illness affecting 50–60% of patients admitted to the Intensive Care Unit (ICU) [1, 2] It is associated with serious short- and long term complications, including increased mortality and contributes to significant healthcare costs [3,4,5]. In healthy individuals without systemic hypertension, intrarenal blood flow is auto-regulated at renal perfusion pressures between 60 and 100 mmHg [6]. During critical illness, these processes may be compromised. Most evidence stems from studies in patients with cardiovascular disease where an association between renal venous
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