Haodong Zhao, Jiongjiong Cheng, Jia Chen, Yu Wang, Xinran Liu, Baoping Cai
Department of Emergency Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
Department of Emergency Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
Ren Fail. 2025 Dec;47(1):2494043. doi: 10.1080/0886022X.2025.2494043. Epub 2025 Apr 24.
Acute pancreatitis (AP) is a common gastrointestinal disorder, and acute kidney injury (AKI) is a frequent and severe complication, significantly increasing mortality risk. Mean arterial pressure (MAP) is crucial for maintaining organ perfusion in critically ill patients. However, the optimal MAP target for minimizing mortality in AP patients complicated by AKI (AP-AKI) remains unclear. This retrospective cohort study analyzed data from the MIMIC-IV database, including 934 critically ill adult patients diagnosed with AP-AKI between 2008 and 2019. We investigated the relationship between MAP and in-hospital mortality using logistic regression models, adjusting for demographics, comorbidities, disease severity scores and intensive care interventions. Smooth curve fitting was used to explore potential non-linear associations. Subgroup analyses were performed to assess the impact of MAP across different clinical and demographic groups. Our analysis revealed a non-linear, L-shaped relationship between MAP and in-hospital mortality, with an inflection point at 71.32 mmHg. Below this threshold, increasing MAP was associated with significantly decreased odds of mortality (OR: 0.93, 95% CI: 0.87-0.99, = 0.026). However, above this threshold, the association was no longer significant (OR: 1.015, 95% CI: 0.98-1.03, = 0.699). Subgroup analyses showed consistent trends across most subgroups, with the benefit of maintaining MAP above the threshold being most pronounced in AKI stage 1 and 2 patients. This study suggests a potential association between maintaining specific MAP levels, particularly above 71.32 mmHg, and reduced in-hospital mortality in critically ill AP-AKI patients.
急性胰腺炎（AP）是一种常见的胃肠道疾病，急性肾损伤（AKI）是其常见且严重的并发症，会显著增加死亡风险。平均动脉压（MAP）对于维持危重症患者的器官灌注至关重要。然而，对于合并AKI的AP患者（AP-AKI），将死亡率降至最低的最佳MAP目标仍不明确。这项回顾性队列研究分析了MIMIC-IV数据库中的数据，包括2008年至2019年间被诊断为AP-AKI的934例成年危重症患者。我们使用逻辑回归模型研究了MAP与院内死亡率之间的关系，并对人口统计学、合并症、疾病严重程度评分和重症监护干预进行了调整。采用平滑曲线拟合来探索潜在的非线性关联。进行亚组分析以评估MAP对不同临床和人口统计学组的影响。我们的分析揭示了MAP与院内死亡率之间存在非线性的L形关系，拐点为71.32 mmHg。低于该阈值时，MAP升高与死亡率显著降低相关（OR：0.93，95%CI：0.87-0.99，P = 0.026）。然而，高于该阈值时，这种关联不再显著（OR：1.015，95%CI：0.98-1.03，P = 0.699）。亚组分析显示大多数亚组的趋势一致，在AKI 1期和2期患者中，将MAP维持在阈值以上的益处最为明显。这项研究表明，维持特定的MAP水平，尤其是高于71.32 mmHg，与危重症AP-AKI患者降低院内死亡率之间可能存在关联。
