journal article

Journal Article

Text

Critical Care. 2016, 20, p. 405

Early-phase cumulative hypotension duration and severe-stage progression in oliguric acute kidney injury with and without sepsis: An observational study

BioMed Central Ltd.

English

Text

2016-12-19

https://doi.org/10.1186/s13054-016-1564-2

Izawa, J., Kitamura, T., Iwami, T. et al. Early-phase cumulative hypotension duration and severe-stage progression in oliguric acute kidney injury with and without sepsis: an observational study. Crit Care 20, 405 (2016). https://doi.org/10.1186/s13054-016-1564-2

Background: Managing blood pressure in patients with acute kidney injury (AKI) could effectively prevent severe-stage progression. However, the effect of hypotension duration in the early phase of AKI remains poorly understood. This study investigated the association between early-phase cumulative duration of hypotension below threshold mean arterial pressure (MAP) and severe-stage progression of oliguric AKI in critically ill patients, and assessed the difference in association with presence of sepsis. Methods: This was a single-center, observational study conducted in theICU of a university hospital in Japan. We examined data from adults with oliguric AKI who were admitted to the ICU during 2010-2014 and stayed in the ICU for ≥24h after diagnosis of stage-1 oliguric AKI defined in the Kidney Disease Improving Global Outcomes (KDIGO) guidelines. The primary outcome was the progression from stage-1 oliguric AKI to stage-3 oliguric AKI (progression to oligoanuria and use of renal replacement therapy) according to the KDIGO criteria. During the first 6h after oliguric AKI, we analyzed the association between cumulative time the patient had below threshold MAP(65, 70, and 75mm Hg) and progression to stage-3. Results: Among 538 patients with oliguric AKI, progression to stage-3 increased as the time spent below any threshold MAP was elongated. In the multivariable analysis of all patients, longer hypotension time (3-6h) showed significant association with stage-3 progression for the time spent below MAP of 65mm Hg (adjusted odds ratio (OR) 3.73, 95% confidence interval (CI) 1.53-9.09, p=0.004), but the association was attenuated for the threshold MAP of 70mm Hg (adjusted OR 2.35, 95% CI 0.96-5.78, p=0.063) and 75mm Hg (adjusted OR 1.92, 95% CI 0.72-5.15, p=0.200). Longer hypotension time with the thresholds of 65 and 70mm Hg was significantly associated with the risk of stage-3 progression in patients without sepsis, whereas the association was weak and not significant in patients with sepsis. Conclusions: Even in a short time frame (6h) after oliguric AKI diagnosis, early-phase cumulative hypotension duration was associated with progression to stage-3 oliguric AKI, especially in patients without sepsis.

© 2016 The Author(s). This article is licensed under a Creative Commons Attribution 4.0 International License.

78400

Early-phase cumulative hypotension duration and severe-stage progression in oliguric acute kidney injury with and without sepsis: An observational study

BioMed Central Ltd.

English

2016-12-19

Critical Care

20

405

https://doi.org/10.1186/s13054-016-1564-2

27993157

https://hdl.handle.net/11094/78400