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Observational Study
. 2013 Dec 13;17(6):R295.
doi: 10.1186/cc13161.

Hemodynamic variables and progression of acute kidney injury in critically ill patients with severe sepsis: data from the prospective observational FINNAKI study

Meri Poukkanen, Erika Wilkman, Suvi T Vaara, Ville Pettilä, Kirsi-Maija Kaukonen, Anna-Maija Korhonen, Ari Uusaro, Seppo Hovilehto, Outi Inkinen, Raili Laru-Sompa, Raku Hautamäki, Anne Kuitunen, Sari Karlsson; FINNAKI Study Group
Collaborators
Observational Study

Hemodynamic variables and progression of acute kidney injury in critically ill patients with severe sepsis: data from the prospective observational FINNAKI study

Meri Poukkanen et al. Crit Care. .

Abstract

Introduction: Knowledge of the association of hemodynamics with progression of septic acute kidney injury (AKI) is limited. However, some recent data suggest that mean arterial pressure (MAP) exceeding current guidelines (60-65 mmHg) may be needed to prevent AKI. We hypothesized that higher MAP during the first 24 hours in the intensive care unit (ICU), would be associated with a lower risk of progression of AKI in patients with severe sepsis.

Methods: We identified 423 patients with severe sepsis and electronically recorded continuous hemodynamic data in the prospective observational FINNAKI study. The primary endpoint was progression of AKI within the first 5 days of ICU admission defined as new onset or worsening of AKI by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. We evaluated the association of hemodynamic variables with this endpoint. We included 53724 10-minute medians of MAP in the analysis. We analysed the ability of time-adjusted MAP to predict progression of AKI by receiver operating characteristic (ROC) analysis.

Results: Of 423 patients, 153 (36.2%) had progression of AKI. Patients with progression of AKI had significantly lower time-adjusted MAP, 74.4 mmHg [68.3-80.8], than those without progression, 78.6 mmHg [72.9-85.4], P < 0.001. A cut-off value of 73 mmHg for time-adjusted MAP best predicted the progression of AKI. Chronic kidney disease, higher lactate, higher dose of furosemide, use of dobutamine and time-adjusted MAP below 73 mmHg were independent predictors of progression of AKI.

Conclusions: The findings of this large prospective multicenter observational study suggest that hypotensive episodes (MAP under 73 mmHg) are associated with progression of AKI in critically ill patients with severe sepsis.

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Figures

Figure 1
Figure 1
Flowchart of study patients with severe sepsis with or without primary endpoint. Primary endpoint = progression of acute kidney injury (AKI) = new onset of AKI (Kidney Disease: Improving Global Outcomes (KDIGO) stages 1 to 3, including initiation of renal replacement therapy) or worsening of AKI by at least one KDIGO stage during the first 5 days of ICU admission.
Figure 2
Figure 2
Progression of acute kidney injury (AKI) by quintiles of time-adjusted mean arterial pressure (MAP). The incidence of progression of AKI divided in quintiles of time-adjusted MAP presented for patients with severe sepsis during the first 24 h in the ICU.
Figure 3
Figure 3
Progression of acute kidney injury (AKI) by quintiles of highest dose of norepinephrine. The incidence of progression of AKI divided in quintiles of highest dose of norepinephrine is presented for patients with severe sepsis during the first 24 h in the ICU.
See this image and copyright information in PMC

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