Abstract
Microcirculatory disorders have been consistently linked to the pathophysiology of sepsis. One of the major organs affected is the kidneys, resulting in sepsis-associated acute kidney injury (SA-AKI) that correlates considerably with mortality. However, the potential role of clinical assessment of peripheral perfusion as a possible tool for SA-AKI management has not been established. To address this gap, the purpose of this study was to investigate the prevalence of peripheral hypoperfusion in SA-AKI, its association with mortality, and fluid balance. This observational cohort study enrolled consecutive septic patients in the Intensive Care Unit. After fluid resuscitation, peripheral perfusion was evaluated using the capillary filling time (CRT) and peripheral perfusion index (PI) techniques. The AKI was defined based on both serum creatinine and urine output criteria. One hundred and forty-one patients were included, 28 (19%) in the non-SA-AKI group, and 113 (81%) in the SA-AKI group. The study revealed higher peripheral hypoperfusion rates in the SA-AKI group using the CRT (OR 3.6; 95% CI 1.35-9.55; p < 0.05). However, this result lost significance after multivariate adjustment. Perfusion abnormalities in the SA-AKI group diagnosed by both CRT (RR 1.96; 95% CI 1.25-3.08) and PI (RR 1.98; 95% CI 1.37-2.86) methods were associated to higher rates of 28-day mortality (p < 0.01). The PI's temporal analysis showed a high predictive value for death over the first 72 h (p < 0.01). A weak correlation between PI values and the fluid balance was found over the first 24 h (r = - 0.20; p < 0.05). In conclusion, peripheral perfusion was not different intrinsically between patients with or without SA-AKI. The presence of peripheral hypoperfusion in the SA-AKI group has appeared to be a prognostic marker for mortality. This evaluation maintained its predictive value over the first 72 hours. The fluid balance possibly negatively influences peripheral perfusion in the SA-AKI.
Highlights
Sepsis consists of a dysregulated host response secondary to an infection, which leads to organ dysfunction [1]
Perfusion abnormalities in the SA-acute kidney injury (AKI) group diagnosed by both capillary filling time (CRT) (RR 1.96; 95% CI 1.25–3.08) and perfusion index (PI) (RR 1.98; 95% CI 1.37–2.86) methods were associated to higher rates of 28-day mortality (p < 0.01)
The results of this study demonstrated that sepsis-associated acute kidney injury (SA-AKI) patients showed two times higher mortality rates than the non-SA-AKI group and corroborated the findings from the literature
Summary
Sepsis consists of a dysregulated host response secondary to an infection, which leads to organ dysfunction [1]. Even though clinical outcomes have improved [2], sepsis still constitutes a large proportion of the critically ill population and remains one of the most significant causes of death globally [3]. It is the most contributing determinant for developing acute kidney injury (AKI) [4], accounting for 50% of cases in the intensive care unit [5], increasing morbidity and mortality [6]. This dissociation between macro and micro-hemodynamics demonstrates the importance of accessing the perfusion disturbances and septic patients’ microcirculation
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