Decreased renal cortical perfusion post-EGDT is associated with MAKE-30 in sepsis

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care Pub Date : 2024-11-06 DOI:10.1016/j.jcrc.2024.154943

Qiqi Li , Rong Li , Can Wang , Qian Zhang , Qian Zhang , Yan Huo , Yangong Chao , Xiaoting Wang , Zhenjie Hu , Lixia Liu , for the Chinese Critical UltraSound Study Group(CCUSG)

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引用次数: 0

Abstract

Objective

This study explores alterations in renal cortical perfusion post-Early Goal-Directed Therapy (EGDT) in sepsis patients, to investigate its association with major adverse kidney events within 30 days (MAKE-30) and identify hemodynamic factors associated with renal cortical perfusion.

Methods

Sepsis patients admitted to the ICU from Jan 2022 to Jul 2023 were prospectively enrolled. Contrast-enhanced ultrasound (CEUS) assessed renal cortical perfusion post-EGDT. Hemodynamic parameters and renal resistive index (RRI) were collected. Patients were categorized into MAKE-30 and non-MAKE-30 groups. The study examined the association between renal cortical perfusion and MAKE-30, explored the hemodynamic factors related to renal cortical perfusion.

Results

Of 94 sepsis patients, 46 (48.9 %) experienced MAKE-30. Distinctions in pulmonary (P = 0.012) and abdominal infection sites (P = 0.001) and significant SOFA (P < 0.001) and APACHE II scores (P = 0.003) differences were observed. No significant differences in baseline characteristics, vasopressor, or diuretic doses were noted (P > 0.05). Hemodynamic parameters in MAKE-30 and non-MAKE-30 patients showed no significant differences. RRI was higher in MAKE-30 patients (0.71 vs 0.66 P = 0.005). Renal microcirculation parameters, including AUC (p = 0.035), rBV (p = 0.021), and PI (p = 0.003), were lower in MAKE-30. Reduced cortical renal perfusion was associated with an increased risk of MAKE-30. Renal cortical perfusion RT was identified as an independent factor associated with this risk (HR 2.278, 95 % CI (1.152–4.507), P = 0.018). RRI correlated with renal cortical perfusion AUC (r = −0.220 p 0.033).

Conclusion

Despite normal systemic hemodynamics post-sepsis EGDT, MAKE-30 patients show reduced renal cortical perfusion. CEUS-derived RT is an independent factor associated with this change. RRI correlates with renal cortical perfusion.

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EGDT 后肾皮质灌注减少与败血症 MAKE-30 有关

目的本研究探讨脓毒症患者早期目标导向疗法（EGDT）后肾皮质灌注的改变，研究其与30天内主要不良肾脏事件（MAKE-30）的关联，并确定与肾皮质灌注相关的血流动力学因素。方法前瞻性纳入2022年1月至2023年7月入住重症监护室的脓毒症患者。对比增强超声（CEUS）评估了EGDT后的肾皮质灌注情况。收集了血液动力学参数和肾脏阻力指数（RRI）。患者被分为 MAKE-30 组和非 MAKE-30 组。研究考察了肾皮质灌注与 MAKE-30 之间的关联，并探讨了与肾皮质灌注相关的血流动力学因素。观察到肺部（P = 0.012）和腹部感染部位（P = 0.001）的差异，以及显著的 SOFA（P < 0.001）和 APACHE II 评分（P = 0.003）差异。基线特征、血管加压剂或利尿剂剂量无明显差异（P > 0.05）。MAKE-30 和非 MAKE-30 患者的血液动力学参数无明显差异。MAKE-30 患者的 RRI 较高（0.71 vs 0.66 P = 0.005）。MAKE-30 患者的肾微循环参数较低，包括 AUC（P = 0.035）、rBV（P = 0.021）和 PI（P = 0.003）。肾皮质灌注减少与 MAKE-30 风险增加有关。肾皮质灌注 RT 被确定为与这一风险相关的独立因素（HR 2.278，95 % CI (1.152-4.507)，P = 0.018）。RRI 与肾皮质灌注 AUC 相关（r = -0.220 P 0.033）。CEUS 导出的 RT 是与这一变化相关的独立因素。RRI 与肾皮质灌注相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of critical care 医学-危重病医学

CiteScore

8.60

自引率

2.70%

发文量

237

审稿时长

23 days

期刊介绍： The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice. The Journal will include articles which discuss: All aspects of health services research in critical care System based practice in anesthesiology, perioperative and critical care medicine The interface between anesthesiology, critical care medicine and pain Integrating intraoperative management in preparation for postoperative critical care management and recovery Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients The team approach in the OR and ICU System-based research Medical ethics Technology in medicine Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education Residency Education.