Giuseppe Cullaro, Andrew S Allegretti, Cynthia Fenton, Jin Ge, Kavish R Patidar, Jessica Rubin, Arjun Sharma, Jennifer C Lai
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引用次数: 0
Abstract
Background and aims: This study informs how mean arterial pressure (MAP) impacts acute kidney injury (AKI) recovery among all patients hospitalized with cirrhosis, regardless of etiology.
Approach and results: We identified incident AKI episodes among subjects in our cohort of patients with decompensated cirrhosis. AKI was defined as a ≥50% increase in creatinine from an outpatient baseline (≥7 days prior) that required hospitalization. Linear mixed effects models were completed to determine the impact between AKI recovery, MAP, and time. To determine the impact of MAP on AKI reversal, we completed time-dependent Cox regression models with time beginning at the time of peak creatinine and ending at death, discharge, or AKI reversal, among those hospitalized with AKI and those with persistent AKI (≥48 h) We identified 702 hospitalized patients with cirrhosis with AKI. We found those with AKI reversal had, on average, higher MAP (2.1 mm Hg, p <0.05) and a greater increase in MAP over time (0.1 mm Hg per hour, p <0.001). Among all 702 hospitalized patients with AKI and adjusted for confounders, each 5 mm Hg increase in MAP was associated with 1.07× the hazard of AKI reversal ( p <0.01). Similarly, among those with persistent AKI after adjusting for confounders, each 5 mm Hg increase in MAP was associated with a 1.19× greater likelihood of AKI reversal ( p <0.001).
Discussion: Our data demonstrate that MAP significantly increases the likelihood of AKI recovery regardless of severity or injury or AKI phenotype. We believe these data highlight the importance of MAP as a clinical tool to promote kidney function recovery among patients with cirrhosis hospitalized with AKI.
背景:本研究旨在了解平均动脉压(MAP)如何影响所有肝硬化住院患者的 AKI 恢复:本研究旨在了解平均动脉压(MAP)如何影响所有肝硬化住院患者的 AKI 恢复,无论其病因如何:我们确定了失代偿期肝硬化患者队列中的 AKI 事件。AKI的定义是血肌酐(sCr)比门诊基线(≥7天前)升高≥50%,且需要住院治疗。线性混合效应模型用于确定 AKI 恢复、MAP 和时间之间的影响。为了确定MAP对AKI逆转的影响,我们在AKI住院患者和持续性AKI(≥48小时)患者中建立了时间依赖性Cox回归模型,时间从sCr峰值时开始,到死亡、出院或AKI逆转时结束:我们确定了 702 名患有 AKI 的住院肝硬化患者。结果:我们确定了 702 名患有 AKI 的住院肝硬化患者。
期刊介绍:
HEPATOLOGY is recognized as the leading publication in the field of liver disease. It features original, peer-reviewed articles covering various aspects of liver structure, function, and disease. The journal's distinguished Editorial Board carefully selects the best articles each month, focusing on topics including immunology, chronic hepatitis, viral hepatitis, cirrhosis, genetic and metabolic liver diseases, liver cancer, and drug metabolism.