Re-exploring the association between the central venous pressure and the risk of sepsis-associated acute kidney injury according to the latest definition: Analysis of the MIMIC-IV database.

IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL
Yingxiu Liu, Baiqing Ren, Muqiao Cheng, Junming Du, Rongrong Ren
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引用次数: 0

Abstract

Objective: The lack of a standard definition for sepsis-associated acute kidney injury (SA-AKI) makes the association between central venous pressure (CVP) and SA-AKI risk unclear. This study analyzed the relationship between CVP levels and the incidence and mortality of SA-AKI based on the most recent definition of the disease.

Methods: This retrospective observational study utilized clinical records of sepsis patients from 2008 to 2019 admitted to the critical care unit (ICU) and in the Medical Information Mart for Intensive Care IV (MIMIC-IV) database were included. Based on the Acute Disease Quality Initiative (ADQI) definition of SA-AKI, patients were stratified into SA-AKI and non-SA-AKI groups. Patients were further categorized into four groups based on the CVP levels by the optimal prediction of SA-AKI incidence retrospectively. Cox proportional hazards models and a restricted cubic splines (RCS) model were employed to evaluate the relationship between CVP levels and SA-AKI risk. Additionally, Kaplan-Meier survival analysis was conducted to compare disparities in primary and secondary endpoints across groups stratified by CVP levels.

Results: A total of 6129 patients were included. An independent relationship was observed between CVP levels and the risk of SA-AKI (p <0.001). Cox proportional hazards analysis demonstrated that SA-AKI incidence increased by 33% in patients with CVP≥10.19mmHg and 48% in patients with CVP≥13.67mmHg compared to patients with CVP<6.87mmHg. RCS analysis demonstrated a U-shaped association between CVP levels and mortality. In addition, the 90-day mortality risk decreased when CVP was between 4.89 and 13.12 mmHg (p< 0.001).

Conclusion: Elevated CVP levels are associated with the occurrence of SA-AKI in sepsis patients. Maintaining CVP levels between 4.89mmHg and 10.19mmHg may help reduce the incidence and mortality of SA-AKI.

根据最新定义重新探索中心静脉压与败血症相关急性肾损伤风险之间的关系:MIMIC-IV数据库分析。
目的:脓毒症相关急性肾损伤(SA-AKI)缺乏标准定义,使得中心静脉压(CVP)与SA-AKI风险之间的关系尚不清楚。本研究基于SA-AKI的最新定义分析了CVP水平与发病率和死亡率之间的关系。方法:本回顾性观察性研究采用2008年至2019年重症监护病房(ICU)脓毒症患者的临床记录,并纳入重症监护医学信息市场IV (MIMIC-IV)数据库。根据急性疾病质量倡议(ADQI)对SA-AKI的定义,将患者分为SA-AKI组和非SA-AKI组。根据CVP水平对SA-AKI发生率进行回顾性预测,进一步将患者分为四组。采用Cox比例风险模型和限制性三次样条(RCS)模型评估CVP水平与SA-AKI风险之间的关系。此外,进行Kaplan-Meier生存分析,比较按CVP水平分层的各组主要终点和次要终点的差异。结果:共纳入6129例患者。CVP水平与SA-AKI风险之间存在独立关系(p结论:CVP水平升高与脓毒症患者SA-AKI的发生有关。将CVP水平维持在4.89 ~ 10.19mmHg之间可能有助于降低SA-AKI的发病率和死亡率。
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来源期刊
Pakistan Journal of Medical Sciences
Pakistan Journal of Medical Sciences 医学-医学:内科
CiteScore
4.10
自引率
9.10%
发文量
363
审稿时长
3-6 weeks
期刊介绍: It is a peer reviewed medical journal published regularly since 1984. It was previously known as quarterly "SPECIALIST" till December 31st 1999. It publishes original research articles, review articles, current practices, short communications & case reports. It attracts manuscripts not only from within Pakistan but also from over fifty countries from abroad. Copies of PJMS are sent to all the import medical libraries all over Pakistan and overseas particularly in South East Asia and Asia Pacific besides WHO EMRO Region countries. Eminent members of the medical profession at home and abroad regularly contribute their write-ups, manuscripts in our publications. We pursue an independent editorial policy, which allows an opportunity to the healthcare professionals to express their views without any fear or favour. That is why many opinion makers among the medical and pharmaceutical profession use this publication to communicate their viewpoint.
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