Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/23758
Title: Relative Hypotension and Adverse Kidney-related Outcomes Among Critically Ill Patients with Shock- A Multicenter Prospective Cohort Study.
Austin Authors: Panwar, Rakshit;Tarvade, Sanjay;Lanyon, Nicholas;Saxena, Manoj;Bush, Dustin;Hardie, Miranda;Attia, John;Bellomo, Rinaldo ;Van Haren, Frank
Affiliation: Australian National University, 2219, Medical School, Canberra, Australian Capital Territory, Australia
The University of Newcastle, School of Medicine and Public Health, Newcastle, New South Wales, Australia
John Hunter Hospital, Intensive Care, Newcastle, New South Wales, Australia
John Hunter Hospital, 37024, Intensive Care Unit, New Lambton Heights, New South Wales, Australia
The George Institute for Global Health, Critical Care Division, Sydney, New South Wales, Australia
University of Newcastle, Newcastle, New South Wales, Australia
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Royal Prince Alfred Hospital, Sydney, Australia, Sydney, New South Wales, Australia
The Canberra Hospital, Intensive Care Unit, Woden (Canberra) , Australian Capital Territory, Australia
The George Institute for Global Health, University of New South Wales, Sydney, Australia, Sydney, Australia
Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom, Department of Anaesthesia, London, United Kingdom of Great Britain and Northern Ireland..
Issue Date: Nov-2020
metadata.dc.date: 2020-07-02
Publication information: American Journal of Respiratory and Critical Care Medicine 2020; 202(10): 1407-1418
Abstract: There are no prospective observational studies exploring the relationship between relative hypotension and adverse kidney-related outcomes among critically ill patients with shock. To investigate the magnitude of relative hypotension during vasopressor-support among critically ill patients with shock, and to determine if such relative hypotension is associated with new significant acute kidney injury (AKI) or major adverse kidney event (MAKE) within 14 days of vasopressor-initiation. At seven multidisciplinary ICUs, 302 patients, aged ≥40 years, requiring ≥4 hours of vasopressor-support for non-hemorrhagic shock, were prospectively enrolled. We assessed time-weighted-average mean perfusion pressure (MPP)-deficit (i.e., percentage difference between patients' pre-illness basal-MPP and achieved-MPP) during vasopressor-support and percentage timepoints with MPP-deficit >20% as key exposure variables. New significant AKI was defined as two-or-more AKI-stage increase (KDIGO creatinine-based criteria). The median MPP-deficit was 19% [interquartile range: 13-25], and 54% [19-82] of timepoints were spent with MPP-deficit >20%. 73 (24%) patients developed new significant AKI; 86 (29%) patients developed MAKE. For every percentage increase in 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% (2.2-9.8; P=0.002) respectively. Likewise, for every one-unit increase in the percentage timepoints with >20% MPP-deficit, 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. Vasopressor-treated patients with shock are often exposed to a significant degree and duration of relative hypotension, which are associated with new-onset adverse kidney-related outcomes.
URI: http://ahro.austin.org.au/austinjspui/handle/1/23758
DOI: 10.1164/rccm.201912-2316OC
ORCID: 0000-0001-9090-8829
0000-0001-8037-4229
0000-0002-1650-8939
PubMed URL: 32614244
Type: Journal Article
Subjects: Acute Kidney Injury
Blood Pressure
Mean Perfusion Pressure Deficit
Relative hypotension
Shock
Appears in Collections:Journal articles

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