Song Haiying, Liao Yuheng, Hu Haofei, Wan Qijun
Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, China.
Department of Nephrology, Shenzhen University Health Science Center, Shenzhen, Guangdong Province, China.
Ren Fail. 2025 Dec;47(1):2448582. doi: 10.1080/0886022X.2024.2448582. Epub 2025 Jan 6.
Acute kidney injury (AKI) is a common complication in critically ill patients, with approximately 5% requiring continuous renal replacement therapy (CRRT). This study investigated the relationship between mean arterial pressure (MAP) and 28- and 90-day mortality in critically ill AKI patients treated with CRRT.
This secondary analysis of a bicenter, retrospective, observational study included patients with AKI who were treated with CRRT from January 2009 to September 2016. Mortality at 28 and 90 days post-CRRT initiation was analyzed using multivariate regression, generalized additive models, smooth curve fitting, and sensitivity analyses.
A total of 1,142 patients were included, with 28-day and 90-day mortality rates of 62.1% and 71.8%, respectively. In multivariable-adjusted Cox models, MAP was inversely correlated with the risk of 28-day and 90-day mortality after adjusting for covariates. Hazard ratios (HRs) were calculated per 1 mmHg increment of MAP: adjusted HR for 28-day mortality 0.985 ( < 0.00001) and for 90-day mortality 0.987 ( = 0.00002). The adjusted HRs for 28-day and 90-day mortality in patients in the highest tertile of MAP compared with those in the lowest tertile were 0.682 (95% CI 0.543-0.857) and 0.730 (95% CI 0.592-0.899), respectively. Patients were grouped using MAP thresholds of <65 mmHg, 65-71.85 mmHg, and ≥71.85 mmHg, with similar results observed. Sensitivity analyses confirmed the inverse relationship between higher MAP before CRRT and lower mortality.
The higher the MAP before CRRT is, the lower the 28- and 90-day mortality of critically ill patients with AKI who are treated with CRRT.
急性肾损伤（AKI）是危重症患者常见的并发症，约5%的患者需要持续肾脏替代治疗（CRRT）。本研究调查了接受CRRT治疗的危重症AKI患者的平均动脉压（MAP）与28天和90天死亡率之间的关系。
这项对一项双中心、回顾性、观察性研究的二次分析纳入了2009年1月至2016年9月期间接受CRRT治疗的AKI患者。使用多变量回归、广义相加模型、平滑曲线拟合和敏感性分析对CRRT开始后28天和90天的死亡率进行分析。
共纳入1142例患者，28天和90天死亡率分别为62.1%和71.8%。在多变量调整的Cox模型中，调整协变量后，MAP与28天和90天死亡风险呈负相关。每1mmHg MAP升高计算风险比（HR）：28天死亡率的调整后HR为0.985（P<0.00001），90天死亡率的调整后HR为0.987（P=0.00002）。与最低三分位数患者相比，MAP最高三分位数患者28天和90天死亡率的调整后HR分别为0.682（95%CI 0.543-0.857）和0.730（95%CI 0.592-0.899）。使用<65mmHg、65-71.85mmHg和≥71.85mmHg的MAP阈值对患者进行分组，结果相似。敏感性分析证实了CRRT前较高的MAP与较低死亡率之间的负相关关系。
CRRT前MAP越高，接受CRRT治疗的危重症AKI患者的28天和90天死亡率越低。
