Renal resistive index-guided mean arterial pressure titration in sepsis: a prospective single-center, single-blind, parallel-group randomized controlled trial

IF 18.1 1区综合性期刊 Q1 MULTIDISCIPLINARY SCIENCES

Nature Communications Pub Date : 2026-07-17 DOI:10.1038/s41467-026-75398-7

Can Wang, Rong Li, Qiqi Li, Meng Wang, Yan Huo, Yaqi Han, Qian Zhang, Bingqi Lu, Zhenjie Hu, Xiaoting Wang, Yangong Chao, Lixia Liu

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Abstract

In sepsis, optimizing mean arterial pressure (MAP) for organ perfusion remains challenging. We conduct a single-center, single-blind, parallel-group randomized controlled trial enrolling 274 sepsis patients to evaluate whether renal resistive index (RRI)-guided MAP titration (MAP titration group, MTG) reduces 28-day all-cause mortality (primary endpoint) compared with conventional treatment (conventional treatment group, CTG). Post-titration, RRI decreases significantly in the MTG versus CTG (0.61 vs. 0.67, P < 0.001). However, 28-day mortality does not differ (25/138 vs. 36/136; RR 0.69, 95% CI 0.44-1.08; P = 0.11). These findings suggest that RRI-guided MAP titration improves renal hemodynamics but does not reduce mortality in this single-center trial; multicenter confirmation is warranted. (Chinese Clinical Trial Registry, ChiCTR2200057136, registered 1 March 2022; https://www.chictr.org.cn/showprojEN.html?proj=153154 ).

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脓毒症中肾抵抗指数引导的平均动脉压滴定：一项前瞻性单中心、单盲、平行组随机对照试验

在脓毒症中，优化器官灌注的平均动脉压（MAP）仍然具有挑战性。我们进行了一项单中心、单盲、平行组随机对照试验，纳入274例脓毒症患者，以评估肾抵抗指数（RRI）引导的MAP滴定（MAP滴定组，MTG）与常规治疗（常规治疗组，CTG）相比，是否能降低28天全因死亡率（主要终点）。滴定后，MTG组与CTG组相比，RRI显著降低（0.61比0.67,P < 0.001）。然而，28天死亡率没有差异（25/138 vs. 36/136; RR 0.69, 95% CI 0.44-1.08; P = 0.11）。这些发现表明，在这项单中心试验中，磁共振引导的MAP滴定可改善肾脏血流动力学，但不能降低死亡率；多中心确认是必要的。（中国临床试验注册中心，ChiCTR2200057136，注册日期为2022年3月1日；https://www.chictr.org.cn/showprojEN.html?proj=153154）。

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来源期刊

Nature Communications Biological Science Disciplines-

CiteScore

24.90

自引率

2.40%

发文量

6928

审稿时长

3.7 months

期刊介绍： Nature Communications, an open-access journal, publishes high-quality research spanning all areas of the natural sciences. Papers featured in the journal showcase significant advances relevant to specialists in each respective field. With a 2-year impact factor of 16.6 (2022) and a median time of 8 days from submission to the first editorial decision, Nature Communications is committed to rapid dissemination of research findings. As a multidisciplinary journal, it welcomes contributions from biological, health, physical, chemical, Earth, social, mathematical, applied, and engineering sciences, aiming to highlight important breakthroughs within each domain.