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Title: Mean arterial pressure and mean perfusion pressure deficit in septic acute kidney injury
Austin Authors: Wong, Benjamin T;Chan, Matthew J;Glassford, Neil J;Mårtensson, Johan;Bion, Victoria;Chai, Syn Y;Oughton, Chad;Tsuji, Isabela Y;Candal, Cristina Lluch;Bellomo, Rinaldo 
Affiliation: Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Australian and New Zealand Intensive Care Research Centre and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Section of Anaesthesia Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
Issue Date: Oct-2015
Publication information: Journal of Critical Care 2015; 30(5): 975-981
Abstract: Background Changes in mean perfusion pressure (MPP) from premorbid resting values may contribute to the progression of septic acute kidney injury (AKI). Objectives In patients with septic shock, we aimed to investigate the association of changes from premorbid values with AKI severity and progression. Methods We obtained premorbid resting mean arterial pressure (MAP), central venous pressure (CVP), and MPP, and then recorded data from intensive care unit admission 2 hourly for the first 24 hours to calculate hemodynamic deficits. We recorded 4-hourly creatinine measurements for 96 hours. The association of hemodynamic variables with progression of AKI by Kidney Disease: Improving Global Outcomes ≥ 2 stages was explored by multivariate logistic regression. Results Of 107 patients, 55 (51.4%) had severe AKI. Median MAP deficit was similar for patients with or without severe AKI. Median MPP deficit was 29% in patients with severe AKI and 24% in those without (P = .04), a difference determined by greater CVP levels. Central venous pressure was independently associated with worsening AKI (odds ratio, 1.26 [95% confidence interval, 1.01-1.58]; P = .04). Conclusions Mean arterial pressure and MPP deficits were substantial in septic shock patients, with patients with severe AKI having a greater MPP deficit. However, only CVP was independently associated with AKI progression. These findings suggest a possible role for venous congestion in septic AKI.
DOI: 10.1016/j.jcrc.2015.05.003
PubMed URL:
Type: Journal Article
Subjects: Hemodynamic targets
Critical care
Acute kidney injury
Central venous pressure
Mean perfusion pressure
Appears in Collections:Journal articles

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