Relative Hypotension and Adverse Kidney-related Outcomes among Critically Ill Patients with Shock. A Multicenter, Prospective Cohort Study
Rationale: There are no prospective observational studies exploring the relationship between relative hypotension and adverse kidney-related outcomes among critically ill patients with shock.Objectives: To investigate the magnitude of relative hypotension during vasopressor support among critically ill patients with shock and to determine whether such relative hypotension is associated with new significant acute kidney injury (AKI) or major adverse kidney events (MAKE) within 14 days of vasopressor initiation.Methods: At seven multidisciplinary ICUs, 302 patients, aged ≥40 years and requiring ≥4 hours of vasopressor support for nonhemorrhagic shock, were prospectively enrolled. We assessed the time-weighted average of the mean perfusion pressure (MPP) deficit (i.e., the percentage difference between patients' preillness basal MPP and achieved MPP) during vasopressor support and the percentage of time points with an MPP deficit > 20% as key exposure variables. New significant AKI was defined as an AKI-stage increase of two or more (Kidney Disease: Improving Global Outcome creatinine-based criteria).Measurements and Main Results: The median MPP deficit was 19% (interquartile range, 13-25), and 54% (interquartile range, 19-82) of time points were spent with an MPP deficit > 20%. Seventy-three (24%) patients developed new significant AKI; 86 (29%) patients developed MAKE. For every percentage increase in the time-weighted average MPP deficit, multivariable-adjusted odds of developing new significant AKI and MAKE increased by 5.6% (95% confidence interval, 2.2-9.1; P = 0.001) and 5.9% (95% confidence interval, 2.2-9.8; P = 0.002), respectively. Likewise, for every one-unit increase in the percentage of time points with an MPP deficit > 20%, multivariable-adjusted odds of developing new significant AKI and MAKE increased by 1.2% (0.3-2.2; P = 0.008) and 1.4% (0.4-2.4; P = 0.004), respectively.Conclusions: Vasopressor-treated patients with shock are often exposed to a significant degree and duration of relative hypotension, which is associated with new-onset, adverse kidney-related outcomes.Study registered with Australian New Zealand Clinical Trial Registry (ACTRN 12613001368729).
| Errataetall: |
CommentIn: Am J Respir Crit Care Med. 2020 Nov 15;202(10):1334-1336. - PMID 32730112 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:202 |
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| Enthalten in: |
American journal of respiratory and critical care medicine - 202(2020), 10 vom: 15. Nov., Seite 1407-1418 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Panwar, Rakshit [VerfasserIn] |
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| Links: |
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| Themen: |
Acute kidney injury |
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| Anmerkungen: |
Date Completed 01.12.2020 Date Revised 01.12.2020 published: Print CommentIn: Am J Respir Crit Care Med. 2020 Nov 15;202(10):1334-1336. - PMID 32730112 Citation Status MEDLINE |
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| doi: |
10.1164/rccm.201912-2316OC |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM311920802 |
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| 100 | 1 | |a Panwar, Rakshit |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Relative Hypotension and Adverse Kidney-related Outcomes among Critically Ill Patients with Shock. A Multicenter, Prospective Cohort Study |
| 264 | 1 | |c 2020 | |
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| 500 | |a Date Completed 01.12.2020 | ||
| 500 | |a Date Revised 01.12.2020 | ||
| 500 | |a published: Print | ||
| 500 | |a CommentIn: Am J Respir Crit Care Med. 2020 Nov 15;202(10):1334-1336. - PMID 32730112 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Rationale: There are no prospective observational studies exploring the relationship between relative hypotension and adverse kidney-related outcomes among critically ill patients with shock.Objectives: To investigate the magnitude of relative hypotension during vasopressor support among critically ill patients with shock and to determine whether such relative hypotension is associated with new significant acute kidney injury (AKI) or major adverse kidney events (MAKE) within 14 days of vasopressor initiation.Methods: At seven multidisciplinary ICUs, 302 patients, aged ≥40 years and requiring ≥4 hours of vasopressor support for nonhemorrhagic shock, were prospectively enrolled. We assessed the time-weighted average of the mean perfusion pressure (MPP) deficit (i.e., the percentage difference between patients' preillness basal MPP and achieved MPP) during vasopressor support and the percentage of time points with an MPP deficit > 20% as key exposure variables. New significant AKI was defined as an AKI-stage increase of two or more (Kidney Disease: Improving Global Outcome creatinine-based criteria).Measurements and Main Results: The median MPP deficit was 19% (interquartile range, 13-25), and 54% (interquartile range, 19-82) of time points were spent with an MPP deficit > 20%. Seventy-three (24%) patients developed new significant AKI; 86 (29%) patients developed MAKE. For every percentage increase in the time-weighted average MPP deficit, multivariable-adjusted odds of developing new significant AKI and MAKE increased by 5.6% (95% confidence interval, 2.2-9.1; P = 0.001) and 5.9% (95% confidence interval, 2.2-9.8; P = 0.002), respectively. Likewise, for every one-unit increase in the percentage of time points with an MPP deficit > 20%, multivariable-adjusted odds of developing new significant AKI and MAKE increased by 1.2% (0.3-2.2; P = 0.008) and 1.4% (0.4-2.4; P = 0.004), respectively.Conclusions: Vasopressor-treated patients with shock are often exposed to a significant degree and duration of relative hypotension, which is associated with new-onset, adverse kidney-related outcomes.Study registered with Australian New Zealand Clinical Trial Registry (ACTRN 12613001368729) | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a acute kidney injury | |
| 650 | 4 | |a blood pressure deficit | |
| 650 | 4 | |a intensive care | |
| 650 | 4 | |a relative hypotension | |
| 650 | 4 | |a shock | |
| 650 | 7 | |a Vasoconstrictor Agents |2 NLM | |
| 700 | 1 | |a Tarvade, Sanjay |e verfasserin |4 aut | |
| 700 | 1 | |a Lanyon, Nicholas |e verfasserin |4 aut | |
| 700 | 1 | |a Saxena, Manoj |e verfasserin |4 aut | |
| 700 | 1 | |a Bush, Dustin |e verfasserin |4 aut | |
| 700 | 1 | |a Hardie, Miranda |e verfasserin |4 aut | |
| 700 | 1 | |a Attia, John |e verfasserin |4 aut | |
| 700 | 1 | |a Bellomo, Rinaldo |e verfasserin |4 aut | |
| 700 | 1 | |a Van Haren, Frank |e verfasserin |4 aut | |
| 700 | 0 | |a REACT Shock Study Investigators and Research Coordinators |e verfasserin |4 aut | |
| 700 | 1 | |a Bush, Dustin |e investigator |4 oth | |
| 700 | 1 | |a Hardie, Miranda |e investigator |4 oth | |
| 700 | 1 | |a Cattigan, Claire |e investigator |4 oth | |
| 700 | 1 | |a Glasby, Laurin |e investigator |4 oth | |
| 700 | 1 | |a Martin, Matthew |e investigator |4 oth | |
| 700 | 1 | |a O'Donoghue, Steve |e investigator |4 oth | |
| 700 | 1 | |a Starr, Therese |e investigator |4 oth | |
| 700 | 1 | |a Nourse, Mary |e investigator |4 oth | |
| 700 | 1 | |a Spiller, Shakira |e investigator |4 oth | |
| 700 | 1 | |a Rodgers, Helen |e investigator |4 oth | |
| 700 | 1 | |a Bone, Allison |e investigator |4 oth | |
| 700 | 1 | |a Brinkerhoff, Gail |e investigator |4 oth | |
| 700 | 1 | |a Eastwood, Glenn |e investigator |4 oth | |
| 700 | 1 | |a Buhr, Heidi |e investigator |4 oth | |
| 700 | 1 | |a Hutch, Debra |e investigator |4 oth | |
| 700 | 1 | |a Wun, James |e investigator |4 oth | |
| 700 | 1 | |a Miller, Jennene |e investigator |4 oth | |
| 700 | 1 | |a Inskip, Debra |e investigator |4 oth | |
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