Department of Medical Intensive Care, University Hospital of Angers, Angers, France.
Service de Biométrie, Institut de Cancérologie de l'Ouest, Centre Paul Papin, Angers, France.
Crit Care Med. 2021 Apr 1;49(4):e412-e422. doi: 10.1097/CCM.0000000000004872.
Individualizing a target mean arterial pressure is challenging during the initial resuscitation of patients with septic shock. The Sepsis and Mean Arterial Pressure (SEPSISPAM) trial suggested that targeting high mean arterial pressure might reduce the occurrence of acute kidney injury among those included patients with a past history of chronic hypertension. We investigated whether the class of antihypertensive medications used before the ICU stay in chronic hypertensive patients was associated with the severity of acute kidney injury occurring after inclusion, according to mean arterial pressure target.
Post hoc analysis of the SEPSISPAM trial.
The primary outcome was the occurrence of severe acute kidney injury during the ICU stay defined as kidney disease improving global outcome stage 2 or higher. Secondary outcomes were mortality at day 28 and mortality at day 90.
All patients with chronic hypertension included in SEPSISPAM with available antihypertensive medications data in the hospitalization report were included.
We analyzed 297 patients. Severe acute kidney injury occurred in 184 patients, without difference according to pre-ICU exposure to antihypertensive medications. Patients with pre-ICU exposure to angiotensin II receptor blockers had significantly less severe acute kidney injury in the high mean arterial pressure target group (adjusted odd ratio 0.24 with 95% CI [0.09-0.66]; p = 0.006). No statistically significant association was found after adjustment for pre-ICU exposure to antihypertensive medications and survival.
Our results suggest that patients with septic shock and chronic hypertension treated with angiotensin II receptor blocker may benefit from a high mean arterial pressure target to reduce the risk of acute kidney injury occurrence.
在脓毒性休克患者的初始复苏过程中，使目标平均动脉压个体化具有挑战性。Sepsis and Mean Arterial Pressure (SEPSISPAM) 试验表明，针对高平均动脉压可能会降低既往有慢性高血压病史的患者发生急性肾损伤的几率。我们根据平均动脉压目标，研究了慢性高血压患者在入住 ICU 前使用的降压药物类别是否与入住 ICU 后发生的急性肾损伤严重程度有关。
SEPSISPAM 试验的事后分析。
主要结局是 ICU 期间发生严重急性肾损伤，定义为肾脏病改善全球结局（KDIGO）分期 2 级或更高。次要结局为 28 天死亡率和 90 天死亡率。
所有纳入 SEPSISPAM 的慢性高血压患者，住院报告中有可用的降压药物数据。
我们分析了 297 例患者。184 例患者发生严重急性肾损伤，与 ICU 前接受降压药物治疗无差异。在高平均动脉压目标组中，ICU 前接受血管紧张素 II 受体阻滞剂治疗的患者严重急性肾损伤明显减少（调整后比值比 0.24，95%CI [0.09-0.66]；p = 0.006）。调整 ICU 前接受降压药物治疗和生存后，未发现统计学显著关联。
我们的结果表明，接受血管紧张素 II 受体阻滞剂治疗的脓毒性休克合并慢性高血压患者可能受益于高平均动脉压目标，以降低急性肾损伤发生的风险。
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