Johannes P C van den Akker1, Jan Bakker2, A B J Groeneveld3, C A den Uil4. 1. Department of Intensive Care Adults, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015GD, Rotterdam, the Netherlands. Electronic address: j.vandenakker@erasmusmc.nl. 2. Department of Intensive Care Adults, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015GD, Rotterdam, the Netherlands; Division of Pulmonary, Allergy and Critical Care, Columbia University Medical Center, New York, NY, USA; Division of Pulmonary, Critical Care and Sleep Medicine, New York University Langone-Bellevue Hospital, New York, NY, USA; Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile. 3. Department of Intensive Care Adults, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015GD, Rotterdam, the Netherlands. 4. Department of Intensive Care Adults, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015GD, Rotterdam, the Netherlands; Department of Cardiology, Erasmus MC, University Medical Center, s-Gravendijkwal 230, Rotterdam 3015, the Netherlands.
Abstract
PURPOSE: In critical illness, the relation between the macrocirculation, microcirculation and organ dysfunction, such as acute kidney injury (AKI), is complex. This study aimed at identifying predictors for AKI in patients with cardiogenic shock. MATERIALS AND METHODS: Thirty-nine adult cardiogenic shock patients, with an admission creatinine <200 μmol l-1, and whose microcirculation was measured within 48 h were enrolled. Patient data were analyzed if AKI stage ≥1 developed according to the Kidney Disease/Improving Outcomes classification within 48 h after admission. Variables with a p < .05 in the univariate analysis were considered for analysis with logistic regression. RESULTS: Twenty-four patients (61.5%) developed AKI within 48 h. The group that developed AKI had higher central venous pressures (CVP), lower diastolic arterial blood pressures and mean perfusion pressures, higher maximum ventilator pressures as well as positive end expiratory pressures and were treated with higher dosages of dobutamine. There was no difference of the microcirculation. In the multivariate logistic regression analysis, CVP was the only independent predictor for AKI (OR 1.241; 95% CI 1.030-1.495; p = .023). CONCLUSIONS: In this population of patients with cardiogenic shock, CVP was associated with the development of AKI.
PURPOSE: In critical illness, the relation between the macrocirculation, microcirculation and organ dysfunction, such as acute kidney injury (AKI), is complex. This study aimed at identifying predictors for AKI in patients with cardiogenic shock. MATERIALS AND METHODS: Thirty-nine adult cardiogenic shockpatients, with an admission creatinine <200 μmol l-1, and whose microcirculation was measured within 48 h were enrolled. Patient data were analyzed if AKI stage ≥1 developed according to the Kidney Disease/Improving Outcomes classification within 48 h after admission. Variables with a p < .05 in the univariate analysis were considered for analysis with logistic regression. RESULTS: Twenty-four patients (61.5%) developed AKI within 48 h. The group that developed AKI had higher central venous pressures (CVP), lower diastolic arterial blood pressures and mean perfusion pressures, higher maximum ventilator pressures as well as positive end expiratory pressures and were treated with higher dosages of dobutamine. There was no difference of the microcirculation. In the multivariate logistic regression analysis, CVP was the only independent predictor for AKI (OR 1.241; 95% CI 1.030-1.495; p = .023). CONCLUSIONS: In this population of patients with cardiogenic shock, CVP was associated with the development of AKI.
Authors: Arif Ali; Tiago Lima Sampaio; Haroon Khan; Philippe Jeandet; Esra Küpeli Akkol; Humaira Bahadar; Alice Maria Costa Martins Journal: Evid Based Complement Alternat Med Date: 2022-05-23 Impact factor: 2.650
Authors: N Ghionzoli; C Sciaccaluga; G E Mandoli; G Vergaro; F Gentile; F D'Ascenzi; S Mondillo; M Emdin; S Valente; M Cameli Journal: Heart Fail Rev Date: 2020-10-02 Impact factor: 4.214