Department of Intensive Care Adults, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015GD, Rotterdam, the Netherlands.
Department of Intensive Care Adults, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015GD, Rotterdam, the Netherlands; Division of Pulmonary, Allergy and Critical Care, Columbia University Medical Center, New York, NY, USA; Division of Pulmonary, Critical Care and Sleep Medicine, New York University Langone-Bellevue Hospital, New York, NY, USA; Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile.
J Crit Care. 2019 Apr;50:11-16. doi: 10.1016/j.jcrc.2018.11.004. Epub 2018 Nov 10.
In critical illness, the relation between the macrocirculation, microcirculation and organ dysfunction, such as acute kidney injury (AKI), is complex. This study aimed at identifying predictors for AKI in patients with cardiogenic shock.
Thirty-nine adult cardiogenic shock patients, with an admission creatinine <200 μmol l, and whose microcirculation was measured within 48 h were enrolled. Patient data were analyzed if AKI stage ≥1 developed according to the Kidney Disease/Improving Outcomes classification within 48 h after admission. Variables with a p < .05 in the univariate analysis were considered for analysis with logistic regression.
Twenty-four patients (61.5%) developed AKI within 48 h. The group that developed AKI had higher central venous pressures (CVP), lower diastolic arterial blood pressures and mean perfusion pressures, higher maximum ventilator pressures as well as positive end expiratory pressures and were treated with higher dosages of dobutamine. There was no difference of the microcirculation. In the multivariate logistic regression analysis, CVP was the only independent predictor for AKI (OR 1.241; 95% CI 1.030-1.495; p = .023).
In this population of patients with cardiogenic shock, CVP was associated with the development of AKI.
在危重病中，宏观循环、微循环与器官功能障碍（如急性肾损伤[AKI]）之间的关系很复杂。本研究旨在确定心源性休克患者发生 AKI 的预测因素。
纳入 39 例成人心源性休克患者，入院时肌酐<200μmol/L，且在 48 小时内测量了微循环。如果在入院后 48 小时内根据肾脏疾病/改善预后分类达到 AKI 分期≥1，则对患者数据进行分析。单因素分析中 p<0.05 的变量将进行逻辑回归分析。
24 例患者（61.5%）在 48 小时内发生 AKI。发生 AKI 的组中心静脉压（CVP）更高，舒张压和平均灌注压更低，最大呼吸机压力以及呼气末正压更高，并且多巴酚丁胺的用量更高。微循环没有差异。在多变量逻辑回归分析中，CVP 是 AKI 的唯一独立预测因素（OR 1.241；95%CI 1.030-1.495；p=0.023）。
在心源性休克患者中，CVP 与 AKI 的发生相关。
