Department of Anesthesiology and Perioperative Care, University of California, San Francisco, CA, USA; Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany.
Department of Anesthesiology and Perioperative Care, University of California, San Francisco, CA, USA.
Br J Anaesth. 2024 Apr;132(4):685-694. doi: 10.1016/j.bja.2023.11.054. Epub 2024 Jan 19.
The peripheral perfusion index is the ratio of pulsatile to nonpulsatile static blood flow obtained by photoplethysmography and reflects peripheral tissue perfusion. We investigated the association between intraoperative perfusion index and postoperative acute kidney injury in patients undergoing major noncardiac surgery and receiving continuous vasopressor infusions.
In this exploratory post hoc analysis of a pragmatic, cluster-randomised, multicentre trial, we obtained areas and cumulative times under various thresholds of perfusion index and investigated their association with acute kidney injury in multivariable logistic regression analyses. In secondary analyses, we investigated the association of time-weighted average perfusion index with acute kidney injury. The 30-day mortality was a secondary outcome.
Of 2534 cases included, 8.9% developed postoperative acute kidney injury. Areas and cumulative times under a perfusion index of 3% and 2% were associated with an increased risk of acute kidney injury; the strongest association was observed for area under a perfusion index of 1% (adjusted odds ratio [aOR] 1.32, 95% confidence interval [CI] 1.00-1.74, P=0.050, per 100%∗min increase). Additionally, time-weighted average perfusion index was associated with acute kidney injury (aOR 0.82, 95% CI 0.74-0.91, P<0.001) and 30-day mortality (aOR 0.68, 95% CI 0.49-0.95, P=0.024).
Larger areas and longer cumulative times under thresholds of perfusion index and lower time-weighted average perfusion index were associated with postoperative acute kidney injury in patients undergoing major noncardiac surgery and receiving continuous vasopressor infusions.
NCT04789330.
外周灌注指数是光体积描记法获得的脉动与非脉动静态血流的比值，反映外周组织灌注。我们研究了在接受持续血管加压素输注的接受非心脏大手术的患者中，术中灌注指数与术后急性肾损伤之间的关系。
在这项实用的、集群随机、多中心试验的探索性事后分析中，我们获得了不同灌注指数阈值下的面积和累积时间，并在多变量逻辑回归分析中研究了它们与急性肾损伤的关系。在次要分析中，我们研究了时间加权平均灌注指数与急性肾损伤的关系。30 天死亡率是次要结果。
在纳入的 2534 例患者中，8.9%发生术后急性肾损伤。灌注指数为 3%和 2%时的面积和累积时间与急性肾损伤风险增加相关；灌注指数为 1%时的面积观察到最强的相关性（调整后的优势比 [aOR] 1.32，95%置信区间 [CI] 1.00-1.74，P=0.050，每增加 100%∗min）。此外，时间加权平均灌注指数与急性肾损伤（aOR 0.82，95%CI 0.74-0.91，P<0.001）和 30 天死亡率（aOR 0.68，95%CI 0.49-0.95，P=0.024）相关。
在接受非心脏大手术和持续血管加压素输注的患者中，较大的灌注指数阈值下的面积和较长的累积时间以及较低的时间加权平均灌注指数与术后急性肾损伤相关。
NCT04789330。
