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

Media Type:

Electronic Article

Year of Publication:

2020

Contained In:

American journal of respiratory and critical care medicine - Vol. 202, No. 10 (2020), p. 1407-1418

Language:

English

Contributors:

Panwar, Rakshit
Tarvade, Sanjay
Lanyon, Nicholas
Saxena, Manoj
Bush, Dustin
Hardie, Miranda
Attia, John
Bellomo, Rinaldo
Van Haren, Frank
REACT Shock Study Investigators and Research Coordinators
Bush, Dustin
Hardie, Miranda
Cattigan, Claire
Glasby, Laurin
Martin, Matthew
O'Donoghue, Steve
Starr, Therese
Nourse, Mary
Spiller, Shakira
Rodgers, Helen
Bone, Allison
Brinkerhoff, Gail
Eastwood, Glenn
Buhr, Heidi
Hutch, Debra
Wun, James
Miller, Jennene
Inskip, Debra

Urls:

Volltext

Keywords:

Acute Kidney Injury
Acute kidney injury
Aged
Australia
Blood pressure deficit
Cohort Studies
Critical Illness
Female
Humans
Hypotension
Intensive care
Journal Article
Male
Middle Aged
Multicenter Study
Prospective Studies
Relative hypotension
Research Support, Non-U.S. Gov't
Shock
Vasoconstrictor Agents

Notes:

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

Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Physical Description:

Online-Ressource

doi:

10.1164/rccm.201912-2316OC

PMID:

32614244

PPN (Catalogue-ID):

NLM312830211